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<br />DISCHARGE MONITORING REPORT (DMR;
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<br />(M2// (22-231 (14251 (2621) R&2B) (3031)
<br />Fonn Approved.
<br />„ , ~ ~ ~ OMB No. 2040-0004
<br />.~ n ~ ^ Approval expires OS-31-98
<br />NOTE: Read InsVUCtions betor m etlng this form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIM WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EXAMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
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<br />.:iChard I`'lIIIS
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<br />Environmental Man~gar INQUIRY OF THOSE INDNIDUAL
<br />THE INFORMATION, I BELIEV
<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTING S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATON IS TRUE,
<br />I AM AWARE THAT THERE ARE SIGNIFICAM
<br />FALSE INFORMATION
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell etfechments here)
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<br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM Td0 WHICH MAY NO7 BE USED.) ~ r) ^ ~ ,I / ~ ~ 1 ~ rl ~ ^ -1 ~ ~ +I PAGE t OF
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