ML18026A430

NPDES Discharge Monitoring Rept for Aug 1993

ML18026A430
Person / Time
Site:	Susquehanna
Issue date:	08/31/1993
From:	Fields J, Saxton C PENNSYLVANIA POWER & LIGHT CO.
To:	Crowley K PENNSYLVANIA, COMMONWEALTH OF
References
CCN-741326, PLE-17241, NUDOCS 9309290311
Download: ML18026A430 (13)

Text

September 23, 1993 Pennsylvania Power & Light Company Two North Ninth Street ~Allentown, PA 18101-1179 ~ 215/774-5151 Ms. Kate Crowley Water Quality Regional Manager Bureau ofWater Quality Management Pennsylvania Department ofEnvironmental Resources 90 East Union Street, 2nd Floor Wilkes-Barre, PA 18701-3296 SUSQUEHANNA STEAMELECTRIC STATION DISCHARGE MONITORlNGREPORT - AUGUST 1993 NPDES PERMIT NO. PA 0047325 CCN 741326 FILER9-8A PLE-17241

Dear Ms. Crowley:

Pursuant to Part A, 3.b.(1) ofNPDES Permit No. PA 0047325, enclosed is the Susquehanna Steam Electric Station discharge monitoring report for August 1993. Also enclosed is Pennsylvania Department ofEnvironmental Resources'onthly Facility Report Form (01-112).

There were no noncompliances in August.

Ifyou have any questions, please call me at (215) 774-7889.

Respectfully yours, rome S. Fields enior Environmental Scientist - Nuclear Enclosures Copies to:

EPA Region III NRC-Document Control Desk NRC Region I Mr. R. J. Clark, NRC Sr. Project Manager jsGltQ216o(26) 93092903ii 93083i PDR ADOCK 05000387 R

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I'01-112 ATTACHMENT 1

PA OEPARTHEHT OF EHYIROHHEHTAL RESOURCES Heath AIL CISL MOHTHLY FACILITY REPORT Oate Prepared

( IIV( l 3 0047325 Incinerator Permit Number(s)

N/A phone Humber (4.lV)D'lZ=l879 Municipal ity Salem Township Coo)nty Luzerne Tele Persan Cantp(et ng Form Curb'S)(SCtxlan Print Name Signature

/p Title 'nvironmental Scientist Facility Name Sus uehanna Steam Elect.ic Station PWS IO HO.

24OQ994 P.O.

Box 467 Facility Address Berwick PA 18603 HPOES Permit Ho.

PA 1.

Total Hours Incinerator Operated 2.

Type of Fuel 3.

Total Fuel Usage 4.

Supplier of Fuel N A N/A N/A N/A N/A 5.

Estimated Amount of Sludge Incinerated 6.

Incinerator Ash Oisposal N/A 7.

Sludge Oisposal Water Treatment (a)

Hau Huch (Tons) 2.9 T<<S (b) Where k'.b Env)runrn nial (c)

When (

st Occurrence (d) Hauler (c) RcCeipts:

Yes Ho

)I )IEI)tt)slic COYIYOTIInenfol Bq's)OIIE l4t6eld,'Pl (a)

How Much (Tons)

(b) Where (c)

When (Last ccurrence (d) Hauler (e) Receipts:

Yes (a)

How Much (Tons)

(b) Where (c) When (Last ccurrcncc (d) Hauler (e) Receipts:

es Ho I

9.

Septic Tank Waste Accepted:

Ycs

/

10.

If yes:

,(a)

Volume (b) Hauler(s Percent (4) Hauled 8.

Other Wastes (Grits, Barscreening, etc.)

\\

l J C(33 a((oYI 0$ S C. lni 12.

Additional Comcnts:

gQ 8

o (ss T~g ~Os qaQ eo((Isns.

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Analysis Performed to ensure tank waste contains no industrial waste (a)

Yes Ha (b) It yves, requency

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(SU BR 02)

OMB No,2040-0004.

F - FINAL Approval explrese-30-91.

RADMASTE TREA.TRENT EFFLUENT NO DATA

)

i

~4'+

NOTE: RSNI Instructions before complatlIIIItIIls form.

PARAMETER (f24/)

AVERAGE MAXIMUM (f Card Only)

QUANTITY OR LOADINO (dd>>ff)

(fdic/)

UNITS MINIMUM AVERAQK MAXIMUM (d Card Only)

QUALITY OR CONCENTRATION

(/deaf)

(dd>>ff)

(SA/1)

UNITS NO>>

KX 62asf)

FIIEGUENCY OF ANALYSIS (6da/d)

SAMPLE TYlat (69.10)

SOLIDS TOTAL SUSPENDED 00530 1

0 0

0 ALU FLOMF IN CONDUIT OR THRU TRBATHENT PLAN 50050 1

0 0

0 SAMPLE MCASURKMKNT SAMPLE CASURCMCNT SAMPLE MEASURKMKNT "Srt>>RMCT4>>"

$CClLIICIE>>sstrdT SAMI'Lt M CASU RIMCNT

,"'~ac'<.'."FtNIT4ITI%,; 2>>

IRKQt/Ihtsst)(T:.

4:0C-C9 4s"~o 'e(x$gg.

%~i",,(P@IJ a -':t4ttxr>>tttl'p$:

OOI(:I>>:

( 03) jg;""44@+0j.

+5 %yfh/@f.

'TItj,,@PAL,.':,"III(vga>>

( 19)

I)G L t(a/ &

g'Sg

)-~egkq; '>>~r SAMPLE MEASUREMKNT

)t.""'St>>S(RMST.'-tr"y sICQ(IIRKICKNT;:

SAMPLE MEASUREMENT

,'. PERMIT i

". REQUIREMENT SAMPLK MEASUREMCNT NAME/TITLEPRINCIPAL EXtCUTIVt OFFICCR g..

c O'terat~

sz.

vp g~~ Oo~mmOuq TYIIIIDOR PRINTED r.>>n I CERTIFY UNOER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED ANO AM fAMILIARWITH THE INFORMATION SVSMITTEO HEREIN; ANO SASCO ON MY tNOtttRY OF THOSE INIXVIOUALS IMMCCttATELY RESPONSISLE FOR OSTAINtNG THE tNSORMATIOtt.

1 SELIEVE THE SUSMtTTEO INSORMATION IS TRUC ACCURATE AHD COMPLETC 1 AM AWARE THAT THCRE ARE SIG.

taFICANT PCNALTtES FOR SUBMITTING FALSE INFORMATION. INCLUIXNG THE POSSIStLITY OF SINE AHO tMPRtSONMENT SEC IS USC I IOGI ANG 33 USC I 1319, tprnattira under thrrr ttatvtrr may tnrtndr /t'nra ap ta Stvlxttt and>>>>r matdmvm tmpnaanmrnt v/hrtvrrn d manlha and 3 yrarnt NATURE 0 PRINCIPAL EX TIVE OFFICCR OR AUTHORIZED OINT TELEPHONE DATC COMMENT AND CXPLANATIONOF ANY VIOLATIONs (Rr/arran vll vuvchtnrnU rra)

FLOM SHALL SE MEASURED DAILY IIHEN DISCHARGING'UMSIR YEAR MO DAY.

EPA Form 3320.1 (Itev. 948) P/evlous edlr/ons may be used.

(RCPLACCS CPA FORM T ~ 0 WHICH MAYNOT SC USED>>I 00585/930611" 1625 1>>AGC OF

PERMITTEE NAME/ADDIIcss(/rtc/uds fecfflty /fsrnsflocatlon (fdgsrsnr/

BhHS MUU5LSXLZMLLti~~~r~IIS~I~ALO AODR~~lLQLGKHf~QL~~>

JLLIJ~M

~MMM3 FACILITY LOCATION 0

EB ECHNOL PERMIT NUMSER oIacHAnaa HUMann MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM TO (2(A2(/

(22 2 /

(2d.

/

f2

~ /

(

/

NATIONALPOLLUTANTOIXCHAROC ELIMINATIONaVSTCM (f(PDCSI DISCHARGE MONITOIEINQIKKPOIKT(D/CRl 2.16 12./ 9 MAJOR Form Approved.

(SU BR 02)

OMB No. 2040-0004.

F.

FIN A L Approval expires 6-30-91; MASTE FILTER BYPASS ap t

NO DATA

)

NOTE: Read InstrUCtiona before compIetilIIIthis form.

PARAMETER (JM1)

AVERAGE MAXIMUM (S Card Only)

OUANTITY OR LOADINO (dIMS)

(SAII )

UNITS MINIMUM AVERAGE MAXIMUM (s Card Only)

QUALITYoR coNccNTRATIDN

(/ILSS)

(4649)

(546/)

UNITS NO.

FREQIICNCY OI'NALYSIS (6dala)

SAMPLE TYPE (69-re)

SOLIDS, TOTAL SUSPENDED 00530 1

0 0

0 OIL AND GREASE FREON HXTR"'GRAV MET 00556 1

0 0

PLOMP IN CONDUIT OR THRU TREATNENT:PLAN'0050 1

0 0

SAMPLE MEASUREMENT AJ gA yaA

. ((PERM'I'T';,";".:r,";,4IiIIIII/'$4>r SAMPLE MEASUREMENT

"'Y'." PvKRii'T~t. 'rh);<.'Ba&oggt'.:

QKcitltltcscKICTs '

s"vier"

'~p,'r'AMPLK MCASUREMCNT SAMPLE MEASUREMENT I 'ur PERMIT ":": "'~ "~pP~+~~

"RKCIUIRKMKii(TI i-"'~'+ e.~i~,'";~+e l"""IrtQQ

/PE""'gr~v'i+)p~o

@;jy9p~

( 03)

~<VC>tit~a F ' )Ag gg4I'Ygg~-

C+4%aF4 Ag'r.',:gP+Pggi'::,:'ism['PatR)h,

( 19)

BG L

( 19) h'A a

ICR/f,"a:

'865

,LOXNQ

",n'.

c SAMPLE MCASURKMCNT

, rrs SAMPLE MCASU R CMCNT SAMI'LK MCASURCMCNT

") KRMIT~:.:;

RCOI/IIIKMKI(Ti NAME/TITLEPRINCIPAL EXECUTIVE OFFICER P

~ (D.

SN A,eve S('

P 0II'~91<IOQ TYPED OR PRINTED I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND AM FAMIUAR WITH THE INFORMATION SUSMITYCD HEREIN; AND SASCD ON MY IHOIIIRY OF THOSC INDIVIDUALS IMMCDIATELY RCSPONSISLK FOR DSTAINatG THE nIFDRMATIDN. I SCUCVE THE SUSMITYED INFORMATION IS TRUC.

ACCURATE AHD COMPLETE.

I AM AWARE THAT THERE ARK SIC.

IAFICANT PEHALTIKS FOR SUBMITTING FALSC IHFDRMATCXI. INCLUCNHG THE PossitnLltY oF Fate AND IMPRisoHMKNT sEc Ie Usc I 1001

$3 USC I 1319.

IPrnattKa andrr thrrr <<atatra may inrladr finrr ap tn dto/aa and nr maaimam tmpnranmrnt af hrtnvrn d mnntha anil 8 >rara I IONATURC OI PRINCIPAL E CUTIVE OFFICER OR AUTHORIZ AOCNT TELKIIHONK NUMSKR YEAR DAT C MO DAY coMMcNT AND cxpLANATIDNoF ANY vloLATIoNs (Rs/stones au <<ftuchrnsnts hsrs)

FLOM SHALL i3E HEASURiD DAILY WHEN DISCHARGING~

EPA Form 3320.1 (Rsv. 948) P/SYtoua ed((tons may be used.

IRCPLACCS EPA FORM T de WHICH MAYNOT SC USCD.I 00589/93061l".1625

~ACE OF r

1

~CRMITTEC NAME/ADDRESS /Jndudc Adt/ltr1/dnuflocetlon /fd/ffcrdnrt mew

~I'&JJt~~M~~uSQllXHZJL ADD" SSZ3$ XL2U)ZEALJkZZLT~S1'~ET

~auns~

mmMM1 PCRMIT NUMSCR OI@CHAROC NUMSXR MONITORINGPERIOD NATIONALPOLLUTANTDISCHARGE CLIMIHATIDHSYSTEM (NPDJ/5/

OISCHAROg MONITOItINOItKI'OI%T/D/t/RJ 2./6

/1/t/

Form Approved (SUBR 02)

OMB No.2040-0004.

FINAL Approval expires 6-30-91.

NEUTRALIZATION BASIN DISCHARGE I

I ACluTY LOCATION C

N YEAR MO DAY YEAR MO DAY FROM

(

(J TO

/20.21J

/22.

J 4

J 1 /

~

1 /

1 HO DATA I

NOTE: Read instructions before complatilILIITIlls form.

PARAMETER (5241) I SOLIDSF TOTAL SUSPENDED 00530 1

0 0

OIL AHD GREASE FREON EXTR:,GRAY MET 00556 1

0 0

~AMPLE MCASURKMCNT

'~'+>/PERMIT"

'IKEIUIIIKIE

KIST, SAMPLE MCASURCMCNT j~(I/cslKRakh".'-"'r'0 stsIEILIIIIKMNff AVCRAOK MAXIMUM I(:~ II:OOn.

rrtt.aaatggli j'Mgaaas:.,

c~cc0c(s 44Q444 (5 Card Only)

OUANTITY OR LOADINO (4')

(5461 )

UNITS MINIMUM g'llIrQ Q nr AVKRAOC MAXIMLIM 2

l (d Cord Only)

DUALITYOR CONCENTRATION (5IL/5)

(d645)-

(546/)

Now CX UNITS (19)Q

( 19)

FREGUCNCY Or ANALYSIS (6dOS)

SAMPLE TYPE (60-10) tie W/3

'@,Rj'S,RA

'/zt 6Re3 PCE/~f R'A'8'.: -,:

FLOW IN CONDUIT OR THRU TREATMENT PLAN 50050 1

0 0

SAMPLE MCASURKMCNT

'IIKcltlslsKssggTL SAMPLE MCASU R CMKNT III(OUf QFKNWI

~AMPLE MCASURKMCNT I;6 tiigPgtj n

-"SOAALI4-

~orhave gjpaaavl o+>

)rn 9I,(X'L$w S$ XH'A

,"," "/PKRQITr""~

7IKEgrlRKMWNT" SAMPLE MCASURCMCNT

,:...!PKRSSIT ":.'.:. ~

'.RKIIUIItgss~

'AMPLE MCASU R CMCNT

'j~'",'-"PERMIT.:;-'Y;

'.IICOUIRKMCNt NAMC/TITLCPRINCIPAL EXECUTIVE OFFICER p, (.

g>q gA~

5'c.

vLJ/=L&dhC.

Of"EgA~LDO3$

TYPED OR PRINTED I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PCRSONALLY CXAMINCD AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HCRKIN. AND SASED DN MY INCWIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSISLE FDR DSTAOIING THE INFORMATCV. I dEUKVE THE SUSMITTCD INFORMATION IS TRUE.

ACCURATE AND COMPLETE.

I AM AWARE THAT THERE ARE SIG.

MFKANT PCNALTIES FOR SUSMITTIIIG F*LSK INFORMATION. INCLUDING THE PDSSISILITY OF FINK AND IMPIIISDNMCNT SCK Id USC I IODI AND 33 USC I 1310.

IPrnaltira dna'rr thrrr atatatrr may tnrta/r /inrr ap la ItttfÃat and vr moaimam impnrvnmrnt a/hrtvwn d mimtha one 8 Irarmt GNATURC PRINCIPAL CX UTIVC OFI'ICER OR AUTHORICCO AGENT TELEPHONE NUMSCR YEAR DATC MO DAY coMMcNT AND cxl'LANATIDNQF ANY vloLATIoNS (Rc/crcncc ou vttvchmcntl crc)

FLOW SHALL BE HEASUIRED DAILY WiiEN DISCHARGING'vEII~

FLOW SHALL BE IIEASURED DEWILY 48EH DISCHARGING'

'HERE SHALL-BE Nct'DISCHARGE OF POLYCHLORIHATED BIPH>NYL COMPOUNDS'EE PERHIT FOR OTH a

o

) Pmv/oua edit/one may be used.

(REPLAcds EPA FGRM TAO vcHIcN MAYNoT SE Usco.i 00592/930611~1625 1

tcRMITTEE NAMEIADDltdss((nttudt Fcdtlry Nant/Lotarlfn tfdgtrNUJ

~~~JgJ~~~

$~~ fiick hDDRESSZM ~EQL~lfiMJKfD FACILITY LOCATION A TN:

R. L.

nOTV SUPV OIER TE'HNOL NATIONAI.FOLLUTANTDISCHAROS ELIMINATIONSYSTEM (h'PDESJ DISCHAltOL'ONIYOIIINOI%RPOICT (DI(lt/

I Ill (739 00 7325 471 A

PKltMITNUMSER OlaCHAROE NUMacn MONITORING PERIOD YEAR MO DAY YE'AR MO

'AY FROM TO (arg i(

3 Form Approved.

(SU BR 02)

OMB No,2040-0004.

F

-" FINAL Approvalexpires6-30-91.-

.'lASTE FXLZr:R EFFLUENT I

NO DATA

)

NOTE: Read Instructions befor completlnilthis form.

PARAMETER (NQP)

SOLIDS'OTAL SUSPENDED 00530 1

0 0

LUZN G

OSS VALU SAMI'LC MEASURCMKNT g.;~i"pcRLIIT6 v

'ltcctI)IRcsc~

AVCRAOC MAXIMUM 0" OI( IW~

UNITS

<<'"ci,a0$ uaac, c I.,tOY, 4444K (3 Card Only)

QUANTITY OR LOADINO (dIL53)

(5Atl)

(d Card Only)

(3ILdf)

MINIMUM IS+0 ~wpfr($4fJ(rr($~CIpc AVERAGE MAXIMUM UNITS

( 19)

,;"IJOI'ea 0,,',)$ jiQ~%.";,,"i I.>HtL)"AVER":-I'45'AI51~5X lkG/L QUALITYOR CONCENTRATION (diL53)

(54dl)

NO.

d?u)3) nicccc ',

FRCOUKNCY OI'NALYSIS SAMPLE TYPE (d9-70)

OIL AND GREASE FREON EXT R,<<'GRAV I%ET 00556 1

0 0

LU' G

SS V

U FLOM F IN CONDUIT OR THRU TREATMENT PLAN 50050 1

0 0

0 A

SAMPLK MEASURCMKNT SAMPLK EASURKMCNT ICCCIIIIRSICNST'AMPLE MCAS UR KMKNT "4) ~",,"tgLgc'Cod,~,',jg:.

~j",,:RRP,og f>%',

• 'i Pj,',.'gP,.6 Rxj' 03)

Quc Jc J nc Icosa!utcaeg@>>

nag@6

~,,"ccr.~III ctK ~$Q$

19) t'NAP>>;

'(g~'~k'+~5Ic8X 8 G L.

~ I"4 I) 0-Cc4

t( 4pp44gg'~ "4+0

,gpss/;,,::

Rk,l'.;

~8GRTH

~ r~':.

. AXEY~,:;,,LOX8

'.-8%(ltcH)KSCKN);

SAMPLE MEASURCMKNT

<<@ RKatKNT:

g~

"gc'dgs'.c~vc

'.v<; <

vr V)c SAMPLE MEASUREMENT

'."'uiRniiITr'p'"IICQUIICKMCSIt'AMPLC MKASURCMCNT PFERMiT',r:,

'RCQUIQCMCNTc c.c

)v Y

cardccurP '

g'pp' gv.p'I ji'~.

cv c ~

NAME/TITLEtRINCIPAL EXECUTIVE OFFICCR g.(". Gqa>eri Sc. YP NuLL-S.CL(t QC&R-A ( IOW TYl'ED OR tltlNTCD I CKltrIFY UNDER tEHALTY DF LAW THAT I HAVE FCRSOHALLY EXAMINED AND AM FAMILIAR WITH THE REFORMATION SUSMITTED HCltCIN. AHD SASCD ON MY INQUIRY DF THDSC INDIVIDUALS IMMEDIATELY RKSFONSIdLC FOR DSTAIHIHG THE INFDltMATIDN. I SKLIKVE THK SUSMITrED INFORMATION IS TltUE. ACCURATE AND CDMFLKIC I AM AWARE THAT THCltC ARE SIG.

InFICANT FCNALTIKS FOR SUSMITTING FALSE INFDltMATIDN. INCLUDING THC FDSSIdcLITY OF FRIC AHD IMPRISONMENT SEC Id USC I 1001 AND

$3 USC I 1319. Itrnaliirr vndrr IArrr rlalvlrr may Inrivdr finrr vp Iu gluprm and cu marimvm unpnrunmrnl ul drrurrn d munthr and d >rara.r

~ ONATU Olr IIIRINCIPAL C CUTIVE OFFICER OR AUTHORIZ AGENT TELClrHONK NUMSCR DATE MO DAY COMMCNT AND EXPLANATIONOF ANY VIOLATIONS (Rt(trtntt au auuthmtnlt htrt)

FLOM SHALL BE MEhSURED DAILY MHEN DISCHARGING'PA Form 3320.1 (Rsv. 048) Prsvtous ed(t(ons may be used.

lltCFLACCS CtA FORM TAO WHICH MAYNOT ~ C USCD.I 0059(I/930611-..1625

~AGE Ot

PcRMITTcK NAME/ADDRcss //ndttdc Fadllty //dtncllocat tun Volrant/

BAH%

gZJULSXLJULBZJL~

~~ILSQOZS Kh ADDRCSS~~g~t JLLLEAQXUs~

lB101 Form Approved.

(SUBR 02)

OMB No.2040-0004.

F F IHAL Approval expires 6-30-91.

571 CIRC HIIATER POI<<PHOVSE SUMP PCRMIT NUMSER DtaCHAIIDS NDMaan MONITOR IN G PER IOD NATIONALPOLLUTANTDISCHARDS ELIMINATIONSYSTSM /NPDE$1 I)ISCHAROg MONITOR(NO RAPPORT (DJ>>JRJ 2 16

/W9 tiA.JQH I ACILITY LOCATION T

S(I V 0 ER ECHHOL YEAR MO OAY YCAR MO OAY FROM CI TO

/20 2/J

/22.2/J

/2d.

J

//2

~ / /

J tiJ DATA NOTE: Read instructions before completil(Nthis form.

PARAMETER (1241)

AVERAOE MAXIMUM (S Cord Only)

OUANTITY OR LOAOINO (dt's/)

(si41 )

UNITS (d Curd Only)

(SSAS)

MINIMUM AVKRAOE MAXIMUM OUALITYoR CONCENTRATION (d642)

($66/)

UNITS No FREDUCNCY OI ANALYSIS 6243)

(666S)

SAMPL,E TYPE (69-10)

SOLI DS F TOTilL SUSPENDED 00530 1

0 0

SAMPLC MEASUREMENT

'>>/PERMIT:

'RKCIU>>IIIKICKt4TF.

¹¹¹¹¹¹

';,Ccc,",'g g", ~rnc,">>

Q I/ g

( 19)

/.~I"<<, g Cg I/I.ir 6e(/

OIL AND GREASE FREON EYTR,GRAV MET 00556 1

5 0

SAMPLE MEASUREMENT IdtaIKRSEIT(~+c "IEKt>>IQIIIKSd~,c a/naca jangle

¹>>r ¹u

¹¹0¹¹¹ b.o 4j;¹4Q~~j C);0;~>>,.'

g, ', g5;Qa;d,@>jk

( 19)

SNCR/~~

FLOMF IH CONDUIT'OR THRO TREATMENT PLAN 50050 1

0 0

SAMPLE

,MEASURKMCNT

>>.s("SIIKRM1T;, +;~ 'c~'.,:$8POgg

,jn';.4,Rg.0RQ~

Ir"¹¹¹¹¹ 1~¹¹¹¹ ¹ I('8'4@0+a(trtc;c 3>~ij(cps>>Q@tc'." Irfjp>>tttctcri'alF

<<ji:.!

. AXIS'j>,J OXN0 SAMPLE MEASUREMENT

'"'.'c'>>PERM IT&r'-"'c SAMPLE MKASURKMKNT SAMPLC MEASU REM CNT

+:Q;,);"c'C '>> 'r; r f'"'w.',',c SAMIrLC MCASURCMKNT

'>>IIVKRMIT,>>'t;;

'REDUIRKM>> KNT NAME/TITLCPRINCIPAL EXECUTIVE OFFICCR Bqg.g(VI S P V'P g (t~(

OPEC.AN te~'YII>>CD OR I RINTKD I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMINED AND AM FAMILIAR WITH THE INFORMATION SUSMITTED HEREIN. AND SXSCD ON MY INDIXRY OF THOSE INDIVIDUALS IMMCDIs>>TELY RCSPONSISLC FDR DSTAINSIC THE INFDRMATID;t. I bELIEVE THE SUSMITTED INFORMATION IS

'TRUE.

ACCURATE AND COMPLETE.

I AM AWARE THAT THERE ARC SID.

taFICANT PENALTIKS FOR SUSMITTIND FALSE INFORMATION. INCLUDINQ THC PDSSIbtLITY Of FSIC AND IMPRISONMENT SEE Ib USC I IDDI AND 33 USC I 1310.

IPrnahica undrr thrrr rtatulrr may inrludr /inrc ap tu Stvsttct and c>>r rrtasimam inrpnrunmrnl u/t>>rt urn d munthn andS >carat I NATURE Olr PRINCIPAL EXEC IVE OFFICER OR AUTHORIZE ENT TELEPHONE NUMSER YEAR DATK MO DA"/

COMMCNT AND CXPLANATIONOF ANY VIOLATIONs (Rc/rrrncc oll unvchmcnls crc)

FLDlt SHE'LL BE MEASURED DAILY ltHEN DISCHARGIHG ~

rc I

rr t

~

r II r

EI>AForm 3320.1 (Rev. 048) Pts vtous ed/1/ons may be used, (RCI'I ACCS CPA FORM TWO WHICH MAYNOT SC USCD>>I 00598/930611>1625 IrAOC Olr