PERMRTEE NAME/ADDRESS (Include Facility Name/Loralion iJDifferenq
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprevBd.
<br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040.0004 .
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDEfl PENALTY OF
<br />AM FAMILIAR WITH THEINFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EIUMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING „_ „/
<br />
<br />Richard MIIIS
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<br />THE INFORMATION, I BELIEV
<br />ACCURATE AND COMPLETE.
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<br />E THE SUBMITTED INFORMATION IS TRUE,
<br />I AM AWARE THAT THERE ARE SIGNIFlCANi
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<br />COMMENTS AND IXPLANATION OF ANY VIOLATIONS (Relarence all attachments here)
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<br />EPA Form 3320.1 (0&95) Previous editions may oot be used: (REPLACES EPA FORM f-42) WHICH MAY NO7 BE U5ED.) n R r ~. 9 / a ~ ~ y t O-1 S 7 q PAGE OF
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