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PERMITTEE NAME/ADDRESS (Includ¢ Farilin• Name/LpCgllOn i/Di$erenr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />NAME DISCHARGE MONITORING REPORT (OMR~
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />BMITTED HER ONALLY EXAMINED AND
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<br /> AMILIA
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<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~
<br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~
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<br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (Re/erence ell ettacnments Here)
<br />SETTLEA5L£ SOLIDS LICIT AF'PLIF;i 04LY IF <=l0YR,2nYA PRF.CIP £V£NT IS CLAICF.D. IF CLAIM aPPAUVED 9Y H[CU,
<br />T55 E IRON LIMITS HILL `JOT rE APPLIED TO REPORT£U CF.AS:)REMENTS - S$E L. A. 2, PG. 5 FOR pDROEN"OF PROOF
<br />120.7 (OB-95) Previous edltlons may no[ be used. ~ -(REPLACES EPA FORM T-40 WHICH MAY NOT.BE USED )~~ {' ~ ~ r ~ ~ ~` ~ PAGE OF
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