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<br />NI•TIONAL FOLLYTwJ CNwRGE ELIMINwTIOM SYSTEM /NPDESI
<br />DISCNARq NITORING REPORT rDMRI
<br />11 l7./9
<br />-lRMIT NDMBER ~ o~scwwncE wurcEw
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
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<br />110~1/I l1T~131 !1 131 l16~1 I 1181 / !30. 11
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<br />f:I'!!IH Form Approv
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<br />F - FIN 4 L Explrea 9.30.91
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<br />PARAMETHR
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERTIFr UNDER PENALTY of LAw THAT
<br />I NAVE v[RSONALLV [IIAMinED
<br />AND wM FAMILIAR WITH THE INFORMATOM SUBMITTED NERCIM
<br />AND MSED TELEPHONE D A T E
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<br />ON MY INQUIRY OF TNOSE INdVIOUALS IMMEdATELY RESPONSrBLE iOR ~
<br /> OBTAINING THE INFdiMATIO:I. I BELIEVE THE SUBMITTED INFORMATION
<br /> 5 TIIUE ACCURATC AND COMVLETE I AM AWARE TNAT TNLRF AIIE SIG
<br />
<br />NIFIUNY VENALTIES FOR SUBNITTMG FALSE INFORMw1gN
<br />INCLUDING ~~1
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<br />TNL rgssl&Lnr a flNF AND IMPT1150NMENT SEE IB usC f 1001 AND
<br />]] USC \ IL9 rRnaR.• undN 1A.r mmly may ,ml
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<br />• BIONATU RE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED ~
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<br />s.d...mc•~mMn,mPww+~n~.,N •J ArrP•Vn6m„nrA•and .i ...F•, OFFICER OR AUTNOgIZED AGENT AR NUMBER YEAR MO DAY
<br />GOM M[N7 AND EJ(PLANATION OF ANY VIOLATIONS (Rr/rrrnrr RU mlPrhrnemT hrre)
<br />SETTLEABLE SOLIUS LI!^7? APPLIRS DMLY IF <= 10-Yit, 24-i(R PREC[P CY6"IT IS CLAI'!EP. If CLAI!1 APFR~VSD BY
<br />f:1CD, TSB f. IROR LIN7TS iJILI. UO? uP .qP?LiEI) TD RSPU°TED MPASL'RE'1ENTS--SEr. T. H.1.1, P; II a'!D 7.TI.lC`, rr, ~.
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