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PERMTTTEE NAME/ADDRESS (include Faci(iry Name/Locorion if Di$rnrnt)
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<br />ADDRESSN L'r?'~ Le?'t ^R'^1tr i`°^{dR4 FR
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />YEAR MO DAY YEAR MO DAY
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<br />R52I/ R2-231 (24-15) Rba]) RB~291 13631)
<br />Form Approved.
<br />OMB No. 2040-0004
<br />"'+ 1 ~ ^ Approval expires OS31-98
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<br />~ NOTE; Read Instructions before~complefing this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 4f}53) (54-81) (38-45) (4&53) (54-61) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
<br />68-70
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<br />NAME/TRLE PRINCIPAL EXECUTIVE OFFCER I CERTIFY UNDER PENALTY OF LAW iHA71 HAVE PERSO
<br />AM FAMILIAR WffH THE INFORMATION SUBMITTED HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON
<br />THE INFORMATION
<br />I BELIEVE THE SUBMTTTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE / /
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<br />ACCURATE AND COMPLETE
<br />I AM AWARE THAT TH ,
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<br />' POSSIBILDV OF FlNE AND IMPRISONMENT. SEE 1B U.S.C. y 1007 AND 33 U.S.C.
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