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<br />PERMfTTEE NAME/ADDRESS pnclude FnciliryNam/[ocanon jDgjerenq
<br />NAME. C;1L'!wti0 CT'AL CCI`1=AGYr L.'r.
<br />ADDRESS('JLOkYO NINE
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<br />FACILITY
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<br />L POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARIGE MONITORING REPORT (DMR;v) w ~ OMB No. 2040-0004
<br />I f` ~ v Approval expires 0531-98
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<br />(2021) ~(211JJ{S7(2'a~15) (15~P]) ". (2829) (30~3p NOTE: Read Instructions before completing this form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FAM FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />ILIAR WITH THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON MY ` TELEPHONE DATE
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<br />INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, C
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOA SUBMITRNG FALSE INFORMATION
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<br />POSSIBILITY DF FINE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S C SIGNATURE OF PRINCIPAL EXECUTIVE <f ~. ~ ~ 2 u- l~ ('~ ~ "~ / . ~ r ~ I(G~
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here)
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<br />'EPA Farm 3320.1 (OB-95) Prrevious editions may not be used. (REPLACES EPA FORM T-40 WHICH
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