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<br />PERMITTEE NAME/ADDRESS pnrlude Facili(v NameJLncalian if D~[/erem)
<br />NAME
<br />Cr!LU"aT~l COFL C.,`IRtiY, L.?.
<br />ADDRESSLp LOkYO ~IN°
<br />`T'!!1 STATE RIGHyAY 13
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<br />LOCATION
<br />°T": J. r. HARi"ON, CFN°T.?.L ~'A`:At:ER
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOESJ
<br />DISCHARGE MONITORING REPORT (OMR; '
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<br />Form Approved.
<br />r I V O H OMB No. 20400004
<br />Approval expires OS-31-98
<br />(~UNR NM)
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />ATION SUBMITTED HEREIN
<br />AND BASED ON MV
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<br />~ TELEPHONE, .; ' ~ DATE
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<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING /
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<br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. \
<br />Lys
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING THE
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<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C.
<br />/SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYPEDORPRINTED § 1319 (Penettint untler these statutes may mclutle litres up ro 510,000 antl w
<br />maximum rmpnsonment of betwcen6months end5yreers:J` ~ j~` OFFICER OR AUTHORIZED AGENT
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<br />V VMMEN I5 ANU tXHLANA I ION UH ANY VIOLATIONS (HetelenCB ell alhtlchmeh[S heBf ~ >; ;tir '
<br />:>ST'.`LEnk+LF SOLIDS LIXIT 3PPLIt:S ONLT IF C=lOTR,24kR Pt;F.'CIP FY'Fw7 IS CLAIN+?D. IF Ct~FI APPROiFO 9Y M'~CU,
<br />TsS 6 IKON LIMITS MILL NOT BE APPLIED TO REPO,R7FD MEASt1AE0FlL~$ _ SEE I.A.2, PG. 5 FCN DLIADFN OF PROOF
<br />320.1 (OB 95). Prewous edlhons may not be used ,,; a`(REPLACES EPA~F.ORM.T-40 WHICH MAY NOT BE~USED.)`. ~ ~' ~ ~ PAGE OF
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