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<br />NATIONAL POLLUTAI ZMMOE ELIMINATION SYSTEM INPDESI Form A' ved.
<br />DISCHARI DNITORING REPORT IOMRI OMB N 140-0004
<br />3-I6. 17-191 ~ : ! ,
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<br />l37-371 EX MALrsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l67~SJ! 164681 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM fA FY UNOFII PENN.TY OF l
<br />MILIM WITH THE INFO AW TNAT I HAVE PERSONNLY ExAMINFD MD
<br />MIATION SUBMITTED MERDM~ MD BASED ON TELEPHONE DATE
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<br />MY INQUIRY OF TNOBF IMDINDUN.S IMMEDIATELY RESPONSIBLE fOR ~ ,/
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<br /> OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ,..,~ ~
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<br /> TRUE, ACCUIUITE MD COMRETF. 1 AM AWME TNAT TMFAE ME I
<br />~ SIONIwCANT PFNKTIES FOR SUeMITTINO FALSE INFORMATION
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<br />EPA~Form 3320=T 108.961 ' Previo e~editioni may b's used. ` (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) PAGE OF
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