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PERMITTa NAME/ADDR[so (IRNade� • - TIOF}AL POLLUTANT Dlefi'NARG[ELIMINATION SYSTEM NPDES Farlllll' Namr/Lxarlon If di em,1) /f ( ) d
<br /> 177.G21.Ly� 1 " IDISCHARGE MONITORING REPORT POf[I
<br /> .'��.yg I OMB No.20/0000/
<br /> •NAML—Ili• 1 I, I _I.,IM - —�% 1 7-16) 17-19) i h -� FINAtL .-� Approvdaphu12-31-V
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<br /> (10-71) (77-33) ( 4-75) ( 62 ) (l6.79).(30-31) NOTE:Read intlroetlone bsloro comptatlnq thle form.
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<br /> NAML/TITLE PRINCIPAL EXECUTIVE OFFICER ^I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED« _ y , TLLEPMON! D A TE
<br /> •NO AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASED r li _
<br /> ON MY INWIRY OF THOSE INpy10U1L5 IMMEDIATELY RESPONSIBLE FpI �{ I c
<br /> 1 V I `• r i�� -, / OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATIOry ' ,J ^ J U T� J `
<br /> IS TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG
<br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING
<br /> THE POSSIBILITY OF TINE AND IMPRISONMENT SEE 16 USC 1 1001 AND - •f
<br /> 33 USC 11318 IF+neXvP uMn tA„r ilelmn me♦ mrludr/mr. uy m lln,Iwn 'B NATURE OF-PRINCIPAL.EXECUTIVE' , f ^ � J` �U Z
<br /> T PED'OR HINTED ,/ and n.menmFm lmannmmvnr,./MWvn 6l mnn,A.rnd.5.wr.r i'_OFFICER Z .
<br /> AUTMORIZEO AOLNT�ti NUMBER YEAR MO. DAY
<br /> COMMENT AND I EXPLANATION OF ANY VIOLATIONS (Rclerenrr all alrarhmenrs hrrr) ; G ,- O y, ' -_ O `y -
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<br /> EPA Form 3320.1 eY. I O.79)PREVIOUS EDITION TO BE USED (REPLACES CPA PORN f••SO RIMICM MAY NOT B[ USED.)
<br /> UNTIL SUP PLY 16 EXHAUSTED VUL Oc/ L, y(rD 01'L]LV PAGE OF
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