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PERMITTEE NAME/ADDRESS (l~(ude F'aciliry Nmnd/ncarion i/Digerem/
<br />NAME Cvp3115 tA4DA YALLPt ~OAL CON P.
<br />ADDRESS'L!7=5 L,lS3 Sf,~TP, s•.?ypN S'Y
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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (OMB;
<br />R-1B) (f l- 9)
<br />~J^'127]54 0!17 e
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 'f I TO ~~ '' '
<br />(20-211 (z2~43) Ra-ZS) (2G~]I (~8-29) (3P31)
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<br />Form Approved.
<br />„ ~ T D,t OMB No. 2040-0004
<br />(~ •I r1 D ~ 1+1 Approval expires 05-31-95
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<br />NOTE: Reed Instructions before completing this form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMIUAfI WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMTRED HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br />
<br />
<br />Richard p4ills
<br />INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV
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<br />E THE SUBMTRED IN
<br />SIBLE FOR OBTAINING
<br />FORMATION IS TRUE, r
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<br />EnvirolT;nental Manager ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTIN I AM AWARE THAT TH
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<br />NUMBER
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<br />CLAIMF,D• SB^. I.A.?, P: 19, P^,R RIIRDEN DP PRJDp REC11iL4?~!F 9*S~ OTL r -oo+r C_rro n--^~.. -,.-. -, ~ ~•
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<br />EPA Form 3320.1 (08-95) Previous editions mey not be used. (REPLACES EPA FORM TRIO WHICH MAY NOT BE USED.) ~ D? ~ ] / n T n rI i ~_ T ~ ~ r, PAGE ~ OF
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