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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2161 lO- 9)
<br /> Cn; 0271-`•U Opt. ',
<br /> PERMIT NUMBER DISCHARGE NUMBER
<br /> MONITORING PERIOD
<br /> YEAR MO DAY YEAR MO DAY
<br />FROM v •• '1'* 111 TO ~ v;c J ~~
<br />(4(}211 (282J) (24251 (46-2]) (2E~29) (3PJ1)
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<br />Form Approvetl.
<br />OMB No. 2040-0004
<br />Approval expires 05-31-9R
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<br />NOTE: Read Instructions before completing this form.
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<br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV '
<br />Richard Mills INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />
<br />Environmental Manager THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TROE,
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THEPE ARE SIGNIFICANT /f
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<br />97O-Q]Q-2]}2
<br />
<br />PENALTIES FOR SUBMITPNG FALSE INFORMATION
<br />INCLUDING THE ~
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<br /> OSSIBILITY OF FINE AND IMPRISONMENT. SEE 1e U.S.C § tppl AND 33 U.S.C.
<br />4 131 B
<br />(PeneXies antler lhesa slerNes may include Imes up l0 516
<br />000 entl a SIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED .
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<br />EPA Form 332b1 (08-95) Previous editions may nol be used. (REPLACES EPA FORM Td0 WHICH MAY NOT:BE,USED.) , T ~ ,: _ PAGE 2 OF
<br />JC016/;i~.Up 15G1
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