PERMITTEE NAME/ADDRESS I /nclude
<br />F~rlllty Name Lcenlpn If dllYe,enU -
<br />NAME STetit~'u:u.-i-~L~Ai2.-LL11~__
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<br />FACILJTY
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SY6TEM (IVPOFS)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />(1-I6) (17-19)
<br />:-n000U213 OU3 A
<br />PERMIT NUMBER onrxwwoe xuxeew
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ I TO
<br />(1611) (J1-17) (14-15) (16-17) (18-19) (JO-ll)
<br />:lINOR
<br />(5 U U R W C) 54SVR1-Pl~v~.
<br />F- f I V A L OMB No. 2040-0004
<br />O N D R U K O f F~R`Shfs~!'BT~Pf17E"~ R A W
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<br />ANALY55 ,
<br />TYPE
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnFY UNDER PENALTY OF LAW THwT I HAVE PERSONALLY E%AMINED TELEPHONE D A T E
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<br />' ON MY INOl11RY OF THOSE WDVId1AL5 IMMEDATELV RESFY]NBIc' F FOR
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<br />EPA Farm .3.320-1 (RSV. B•BB) Frevals ediUms l/18y LX? l6BA. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED! ~I ^ ., ,' 1 ~ 7 ~ n pA~ OF
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