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<br />NATIONAL POLLUTANT :SCHARGE ELIMINATION SYSTEM INPDES/
<br />DISCHAR ,~NITORINO REPORT/DMRI
<br />/I-16 ~ 117-19/
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<br />PERYIT NUMBER` r- DISCHARGE NUMBER
<br />MONITORING PERIOD
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER •' :~ CERTI
<br />'AND AM FY UNDER PENALTY OF LAW THAT I HAVE P
<br />FAMILIAR WITH THE INFORMATION SUBMITT ERSONALLY EXAMINED
<br />ED HEREIN' AND BASED ~^ i
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<br />' TELEPHONE -~ DATE '
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<br />~= .~ ~
<br />RICHARD G
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<br />UN ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPdNSIBLE FOR ~ /~ r' c
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<br />,]" OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION _
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<br />VP LANb EN IRUNMENTAL AFFeeIR
<br />Y P IS TRUE, ACCURATE AND COMPLETE. I AM AV(ARE THAT THERE ARE SIG.
<br />NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION; INOLUDINO ~ - ~
<br />303 ~-8$4-4,451 ~'
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<br />' THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE IS tl.S.C.; 1 1001 AND
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<br />COMMENTAND E%PLANATION OFANYVIOIATIONS(Rrlrrrhn aflartarAmena /urq' '' ~' `~ - '' ~ --` - ~'
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