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PERMITTEE NAME/ADDRES$ (Include Faciliry Narrre/Location if Di$ereni) NATIONAL POLLUTANT DISCHARGE EUMINATON SYSTEM (NPDES) Folm Approved.
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<br />' DISCHARGE MONITORING REPORT (DMR;
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<br />n a~T~-; Approval expires 05-37-98
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<br />y jQ17 F1 i^ "I' ~ ° •. ;. ^Tf{^(,c ~~ P UMBER DISCHARGE NUMBER ~ _ ..r" 6~ .; ~..rn
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<br />FACILITY 8h„Lf:GI~ rl ~~1570
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<br />LOCATION ~Of MO DAY YEAR MO DAY __
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<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM IAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MV /~ TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUAL
<br />O S IMMEDIATELY RESPON SIBLE FOR OBTAINING
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<br />~~L'•/~/ /////i/G,,•f/~// 970-II70-2772
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<br />Et1V IEOr11nP r1LAI 'J:a naoer PENALTIES FOR SUBMITTIN
<br />POSSIBILITY OF FINE AND IMPR G FALSE INFO
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<br />ISONMENT. SEE IB U.S.C.410D1 AND 33 U.S.C.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYPED OR PRINTED § 1319. (PoreNas unav Nose stetutas mey Inc/uda Ilnes up ro f10,000 end a
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<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence 811 errecnments nere)
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<br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) n n ~ S n ,~ r I , 5 II PAGE OF
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