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PERMITTEE NAME/ADDRESS (lnchde Facil/ry NmndLacmion ijDi$ermq
<br />NAME ^.v p.,.- Y:~-r - -_ -•.,:L ^v+r,
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />(4481 (f ]- 9)
<br />^'1 ~'77-TTSr! n\7 A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '' 1 ` .r TO a ' '.1 °T ] +1
<br />(4P417 (22-431 (40.451 R&4]) (4&49) (30.711
<br />Forth Approved.
<br />-, ~ T ~ , OMB No. 2640-0004
<br />Approval expires 0531-98
<br />r`r•~n -\
<br />4 NOTE: Read IrlsVuctlons before completing this form.
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<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF IAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br />AM FAMILIAR WfTH THE INFORM
<br />INQUIRY Of THOSE INDNIDUAL
<br />THE INFORMATION, I BELIEV
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<br />^ ATION SUBMITTED HEREIN; AND BASED ON MY . ~ ~
<br />9 IMMEDIATELY RESPONSIBLE FOR OBTAINING / /~
<br />E THE SUBMITTED INFORMATION IS TRUE, I , ,
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<br />I AM AWME THAT THERE ARE 61GNIFlCANT ~ /l? .
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<br />T---~ PENALTIES FOR SUBMITTIN
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<br />pOSSIBIUTY OF FINE AND IMPR ISONMENT. SEE IB U.S.C.~1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYPED OR PRINTED 4 1318. (PanBldee untla. Nose sfeNles may Include Mnes up m S10,OW entl a
<br />maximum lmpdsarme,x of befwsenBmwrth9 mtl5y9ers.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here)
<br />(".-:'i~il"I:•~. 3r1-Gt I tq^„ ,1.; 'U ~a PTI ~.. i~ ~TNG F Vppuq!, AQ~.~,tvrmT.- .r5.. no n>•f ".'T, ~T,~r.. T.- r1o+•5re. o. +. ~.. ~..
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<br />EPA Form 3320.1 (l)8-95) Previous editions may not be used. (REPLACES EPA FORM 7.40 WHICH MAY NOT BE USED.) O ,t .t ,` it / ~ i n ,1 ~ O _ ~ ~ ~ r, PAGE OF
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