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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR;
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />YEAR MO DAY YEAR MO DAY
<br />FROM O U O U ~:• 1 TO U U L 4 j 7
<br />(20-2II (22-23) (2925) (26-211 (2b~291 f30.31)
<br />Form Approved. ,
<br />OMB No. 2040-0004
<br />E: A.i 0 i. Approval expires 05-31-9R
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />ATION SUBMITTED HEREIN; AND BASED ON MV TELEPHONE DATE
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<br />Richard rv1111s INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />NUMBER
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<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS (Aelerence all attachments here)
<br />Lt'T"-.?a 1. '_' 39-UAY fiV=.AAGE CONCF:tiTFATi~i•i 1i51N': A NOF~AL A8ITN1°eTIC NF,A!I Or" ALL e=:KLY E'~•;UL`I= Ue!TRINEU frlc,
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<br />EPA Form 3320-1 (OS-95) Previous editions may not be used. (REPUICES EPA FORM T-40 WHICH MAY NOT BE USED.) 0 D 20 5 / J 0 0 u U 5-1 `~ I; ~ PAGE 1 OF
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