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<br />D 18CHAR NITORIND REPORT /DMRI
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<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO .,
<br />(20~2lI (21-231 11i-1S1 /26. T1 128.291 !30. 1)
<br />n I
<br />"II.ROR Form Approv~a..~
<br />(S U H }? ~ N f!) M Q)AI6T No. 2090-0004
<br />F - FINAL EXplrea 9.30.97
<br />GULCH A SEDI POND/GOOD SFGS CF
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<br /> (3 Card Only) QUANTITY OR LOADING (1 Card Only) QUALITY OR CONCENTRATION
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<br />MEASUREMENT Da!'+%+ rn•r#;# ( ) :tL-,~,,,, ..IInn
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<br />PER90NALLr [XAMINED TELEPHONE D
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<br /> ANO AM FAMILIAR MTH TRC INFORMnTION SUBMITT[D HERON AND BASED
<br /> OH MY INQUIRY OF iH05[ INpVIDULLS IMMLdATCLY RESPONSIBLC FOR
<br /> OBTAINING THE INFORYATIO:1 I BELIEVE THE SUBYIITED INFORMATION
<br /> IS TIRIE 11000RATE AHD COMPERE I AM 1WARC THAT TNERE ARE SIG
<br /> NIFICANT PLNAI,TICS fOR SUBMITTING F11LSE INFORMATION IIVCLUQNG
<br /> THE POSSIBILITT O FINE AND IMPwRONMENT 5[[ IB USC f 1001 AND
<br />]] USC S 1919 /P
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<br />IA
<br />M 61GNATURE OF PRINCIPAL EXECUTIVE
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<br />OFFICER OR AUTNORI2ED AGENT
<br />
<br />A A
<br />
<br />NUMBER
<br />
<br />YEAR
<br />
<br />MO
<br />
<br />DAY
<br />A ON OF ANY VIOLATIONS (RrJrrrnrr ull mmrhmrnla hrrr)
<br />S;TTLEAPLE SO,LiDS LIMIT APPLIF.SI•'OfiiLY 7IF <= 10-YR; 2)1-H9 PBSCIP'f:YI:NT IS CL?.INFO. IF CLA.T!7 ?PP4^y 6L` `l!
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