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PERMITTEE NAME/ADDRESS pnclude Facility NamelLocatlon ifDiperenq
<br />NAME f9APPER 'Si.`~IHI;, I~VC.
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO V 3 3I
<br />Porm Approved.
<br />OMB No. 2040-0004
<br />HINOR
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<br />NOTE: Read Instructions before completing this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FflEOUENC SAMPLE
<br />PARAMETER EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANa.YS/s
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<br />AME/TITLE PRINCIPAL EXECUTIVE OFFICER I Ceniry under penalty of law that Ihls document and ell attachmaMS were
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<br />i TELEPHONE DATE
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<br />Il. Gordon PeterR prepared under my tlvect
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<br />suhmitted Is . to the best of my knowledge antl beliel, true, accurate, and complete.
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<br />i SIGNATURE OF PRINCIPAL EXECUTIVE.
<br />.> TYPED OR PRINTED or submin
<br />lam aware that there ere significant penalties
<br />ng 7alse lMOrmatlon,
<br />in<ludln lha sslblli of line ands Isonmemfor knows violations. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
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<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
<br />C35 ~ TOTAL IR,iN LINIT~ MILL BE fJAIYED, AND Sh~PTLEADL 3uLi65 LI`lI':' APPLI°_D FOR <=IOYH,24HR pRFCIP ~YF.Nf-
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