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PERMITTEE NAME~ADDRESS (Include Facility Name/Locarian ifDifferenQ ,
<br />NAME TH~PpER fiINING, I':".
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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Certiry untler penalty of law mat this tlocument antl all attachments were
<br />i
<br />i TELEPHONE DATE
<br />
<br />
<br />'.~, Gordon Petezs preperetl untler my tlaxtiorr or superv
<br />sion
<br />n eccordenca wiN a system designed
<br />to assure that qualified personn& properly gather and evaluate the information
<br />submitted. Basetlonmyinqulryofrhepemonorpersonswhomarragethesystem,
<br />or those parsons tlvedly responsible Mr gathering the IMOrmation
<br />the Information
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<br />70=824-4401
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<br />President/6enerai Manager ,
<br />submittetl is,to the best of my kno-wletlge and beliel,tve, accurate, and wmplete. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED lam aware that there are significant penaNes for submining lalse mlgrmation,
<br />~ncludina the gassldllN Olfne antl imorlsanmant /or knowing violations. OFFICER OR AUTHORIZED AGENT A
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<br />NUMBER
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<br />COMMENTS AND~EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here)
<br />fi:; :: 'TOTAL ir.Jh (.I(4Ti.i rI1LL tit eAI~F.D. AAD S?;TTL°ASLE iOLIf:S LIdIT APPLIED F04 C=l0YR,24NH P$ECIP ..°.YEN'."-
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