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PERMRTEE NAME/ADDRESS pnclude Faciliry Nmnr/Gocarion ifDiBermQ NATIONAL POLLUfANrDI~HARGE ELIMINATION SYSTEM MPDES) Form Approved.
<br />NAME .i ~ ti - A `,~ A L ;: U 1 t' 6lv Y DISCHARGE MONITORING REPORT (DMR~
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<br />D A (..UF.i NM) Approval ezpire&05-31-98
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<br />H n YDE h C;1 r, 1 ~ J a ;PERMIT NUMBER DISCFTnaGE NUMBER k - FI EIAL {!GU'T
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<br />FACILITY MONITORING PERIOD
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<br /> NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY E](AMINED AND TELEPHONE DATE
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<br />PENALTIES FOR SUBMITTING
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachmen4s here)
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<br />LRJit LItlITi iIAIYtU t'ON >IJfH~24HR PRECIP EVENT SUIi.IECF FU UUiiU6N OF ['HUOr [N L..1.2. UIL b GR6ASt-:;Ei:
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<br />EPA Form 3320.1 (09.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.)
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