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PERMITTEE NAME/ADDRESS (lxhde Farifiry NmrrlGocarion ifDi$ermQ
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />(2-16) ff]- BI
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ' ~ I'' ~ TO ~ 4 t "
<br />(2P2f1 (1223) (24251 (26-2]1 (2829) (3P3f1
<br />Form Approved.
<br />1 1 ~ ~ OMB No. 2040-0004
<br />t ^ ' Approval e>~ires 051-9R
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<br />NAME/TRLE PRINCIPAL IXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMIUM WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EJNMINED AND
<br />IN; AND BASED ON MV ~ TELEPHONE DATE
<br /> IN
<br />RY OF THOSE INDMDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING
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<br />THE INFORMATION. I B HE SUBMI
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<br />Cr1VIrOTImplltal r'}arTElrJPr ACCURATE AND COMPLETE. r AM AWARE THAT TH
<br />F ERE ARE SIGNIFICANT
<br />IN
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<br /> ALSE INFORMATION,
<br />PENALTIES FOR SUBMITTING
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<br />NG THE
<br />POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 16 U.S C. 5 1 W1 AND 33 U.S.C.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE l /
<br />TYPED OR PRINTED ~mum~~~nf of mnrean 8 moonfns~nrd 9uda Ilnav up ro f10,ooo e.M a
<br />pri ymrs.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLAI TUNS (RererenCe all BReCDmenLS De1B)
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<br />LAL`ED iFP :.+.7 }': !.9 a^ n:v ~n ~~~P n^nr- Rq .-~wc nT or _ ... s n....,
<br />~ ~ FOR 4. P I r°. T. r 1.- ~ .n•~.~r r/~ n^ ..
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<br />EPA Form 332x7 (08-95) Previous editions may not be used. (REPLACES EPA FORM 7-40 WHICH MAY NOT BE USED.) ,~ n + ~ T ~,+ ~ ~ „ T ~` ~ ~ ,, ,: PAGE ~ OF
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