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PERMITTEE NAME/ADDRESS pnchde Fadlit}•Namo7octtNOn ifDr$crcnq
<br />NAME f,igPP^R riINI`!CS, iA~.
<br />ADDRESSt• I: A n p; R m I ,y E
<br />P.O. J7X 1`~7
<br />FACILITY y
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM .J I U .)1 TO U 1 U i 3 1
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<br />(SJRR ~ISi)
<br />- F'I SAL
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<br />• ~ ~D DIS^HAH
<br />T NOTE: Read Instruction
<br />Form Approved.
<br />OMB No. 2040-0004
<br />MDF=.T
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. PREOUENC SA LE
<br /> EX OF .TYPE
<br />PARAMETER
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ ~a-ySfs
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<br />- MEASUREMENT
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Cediry under penalry of law thaz this document and all attachments were TELEPHONE DATE
<br />
<br />.~ .prepared under my dvection er supervision in accordance wish a system designed
<br />to assure Mat qualified personnel pmpedy gather entl evaluate the lnformallon
<br />/ /~ .>C"J~{L"~
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<br />W. Gordon Peters aubmiaed, eazetl on myinquiry of the person or persons who manage the system, fir
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<br />]O-E 2~{-~1~1OI
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<br /> or those parsons Directly responsible for palhedng the Inbrmetion, the Information
<br />President/General MBna er submrtled ls,to the best of my knowledgo antl baliep tme, accurate, and cOmplate. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED lam aware that there em signNicant peneWes for submitting false information,
<br />indudin fie ossibili olfne and im dsonmant for knowin violations. OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION 01= ANY v W LA l IUN~ piererence an avacnmenrs nere)
<br />1':i5 S 20TAL IKON LIMITS iii LL UE ~IAIYEU,~AND SL2TLEAULE =DLIDS LIMIT Ak~PLIk:D FOR <=197k~24Nk PRECIP 4YyN't'-
<br />'r:E dJitREN OF PROOP HEyUIRECENTS UNDE!? I.A..9. TDS "ONITORIEC, - I.R.3. OIL 6 GREASE - SEE I. 6. I.(~).
<br />- 4 ~.... ~v .+ ~ 9R1 revlous ~ i ions may a use ~ THIS IS A 4-PART FORM PAGE OF
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