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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprOVed.
<br />DISCHARGE MONITORING REPORT (DMR( OMB No. 2040-0004
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<br />_' 1 D l ~ 7', S ~3 O •i ~ T (~ ? , a y ,., } Approval expires OS-31-98
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<br />NAME?ITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO
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<br />~acl,ard M.III£ INQUIRY OF THOSE INDNIDUAL
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<br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ „, ,t r / ~ T ~ 0 e ~_ ~ r ~ r1 PAGE ~ OF
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