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<br />ADDRESST R A P P E R ~'. I 'I E
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<br />NATIONAL POLLUTAN7 DISCHARGE ELIMINATION SVSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMA)
<br />^ PERMIT NUMBER DISCHARGE NUMBER
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<br />Form Approved.
<br />'1 I N O R OM8 No. 2040-0004 .
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<br />'rFLUAHT GR053 YALUE •A~O~/R ':'' `~"'~''
<br />MAME/TITLEPRINCIPAL EXECUTIVE OFFICER I Ceniry untler penalty of law that this document end all anachments were TELEPHONE DATE
<br /> preparctl untler my direclgn or supervision n accordance wiN a system tlesigned
<br />to assure Nat qualified personnel properly gather and aaluate the in/ormation ~~ ~ ~~
<br />W, Gordon Peters submined. Based onmyinqulryoithaperaonorpersonswhomanagethesystem, 70-824-4401 I 04 26
<br />sldent/General Mena er
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<br />g or those personstlireglyresponslhleforpalhatlnptheiMortnabon,theintortnation
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<br />submined is, to me best of my knowletlpe and belie}, true, accurate, antl comp SIGNATURE OF PRINCIPAL EXECUTIVE
<br />~, TVPED OR PRINTED I am aware Nat (here are significant penalties for subm~ning false inbrmadon,
<br />inclutlln the ossibili olflne andi isonmenl for knowi violations. OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANA nVN OF Arvr vIVIJ111Vrv5 (nererence au attacnmenrs nere) -
<br />'ti5 S TOTAL LHJN LIMITS RILL .i5 ,WAIVED, A,tiD SETTL.R,AP.LE SOLIDS LIMIT APPLIED FOR <=l0YA,24AR PRECIP EVca`i'-
<br />:,L° BURDEN OF PROOF REQUIRcKENTS UVDER I.A.3. TDS rONIT_ORING~- I.b.3. OIL C GREASE - SEE I. B. 1.(D).
<br />n _-- ~a + Got rcvini is a.' i inn may "' ~ ' THIS I~ A 4-PART FORM PAGE OF
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