PERMITTEE NAME/ADDRESS (Include Fotiliy Name/Locannn if Differenq
<br />NAME
<br />COLOIiTO COA4 CGMTdSY, L.F.
<br />ADURESS~O LO rIYO HINB
<br />5731 STATP. HIGHLIAT 13
<br />!1cEXER .~:,~~.,~0 91681
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<br />ATTN: J. U. h1ARP!05, GEM F!79L IAN AGFE
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATIOtJ~SVSTEM (NPDES) FOrm ApprOVBd.
<br />DISCHARIGE MONITORING REPiOBT (DMRI OMB No. 2040-0004
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<br />.crin nn St at Approval expires OS-31-96
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<br />PARAMETER (3 Card Onty) QUANTITY. OR LOADING
<br />r (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br />(32-37) AVEAAGE MAXIMUM N!TS MINIMUM AVERAGE MAXIMUM UNITS
<br />(sz GT) ANALYSIS
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<br />69-70
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<br />NAME(1'ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH T
<br />E INFO LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />~ TELEPHONE DATE
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<br />RMATION SUBMITTED HEREIN; AND BASED ON MY .
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE'ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION; ~INCL`UDING THE
<br />I 1 I1 / 1111 I V POSSIBILITY OF FINE ANO IMPRISONMEM. SEE 1B U.S.C. g 1001 AND 33 U.S.C SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~(~ . J ~~ /L+•vt O / /S y (l
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<br />TYPED OR PRINTED g 1315. (Penatlies untler I~ese stetuTes may Inclutle lines up to 510,000 and or
<br />l OFFICER OR AUTHORIZED AGENT
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