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<br />NATONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDESJ Form Approved.
<br />DISCHARGE MONITORING REPORT (OMR~ v r OMB NO. 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF T
<br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSO
<br />ATION SUBMffTED HERE NALLY EXAMINED AND
<br />IN
<br />AND BASED ON MY TELEPHONE DATE
<br />
<br />Richard P.9ills INQUIRY OF THOSE INDNIDUAL
<br />THE INFORMATION
<br />I BELIEV S IMMEDIATELY RESPON
<br />E THE SUBMITTED INF ;
<br />SIBLE FOR OBTAINING
<br />ORMATION IS TRUE
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<br />Environmental °'ianzger ,
<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTING
<br />I AM AWARE THAT TH
<br />FALSE INFORMATO ,
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<br />970-870-2717. ^
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<br />EPA Form 3320.1 (06.95) Previous edltlons may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) R ~ i T ~ / ? ~ n y 1 ~-1 S ~ N PAGE OF
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