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Form Approved.
<br />PERMITTEE NAME/ADDRESS ((nc(ude Facility Namellocadon ifDij(erenl) NA710NAL POLLUTANTOISCHARGE ELIMINATION SYSTEM (NPDES) OMB NO. 20x0-0004
<br />NAME R I.II c~ r vl u r e r w r u w ~- v r u^ DISCHARGE MONITORING REPORT (DMA) N T I,1 1. '
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<br />1601 ~DUNTY ROA D 65 •NUMBER DI GENUM$E F - FLB
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER ICerty uMer penalty of law that this document end all attachments were TELEPHONE DATE
<br /> pmparetl under my direction or supemsion in ettordance with a system tles~gned
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<br />/ to assure that qualified personnel pmpeAy gather and evaluate the inbrmallon
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<br />submmed. Based on myinqufry al the pCrson orPNSOns who menage t
<br /> or (hose persons tlirecVy responsible br gathering the irdorfnallon, Vie iNOmraOOn
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<br />~ subminetl is , to the best of my knowledge end belie[ true, accurate, antl oomplele. SIGN ATURE OF PRINCIPAL EXECUTIVE I] -
<br /> nificant penalties for aubmining false information
<br />thatthere era si
<br />l ZED AGENT
<br />TH AY
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<br />am aware ORI
<br />OFFICER OR AU NUMBER YEAR MO O
<br />. TYPED'0 PRINTED including the possibility of Bne end imprisonment ror knowin vlolatbns.
<br />U
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a//attachments here) '
<br />I5S ~v TOTAL IRON LItlI'La •iLL ~+F. .RIVED, A`iD SF.TTLEA:.'LB SOLIDS LItlI'[ APPLIt:D FOR <=lOTR,24RR °RECIP -°.VE4T-
<br />SF:6 I.A.l, PG Y, FOR REtOT_RENF;NTS. JIL `~ ':`<<.AtiE REPORTING-SPE I.d.1.F, P; YII. ORTRLT SAMPLING
<br />_ A orm 3 1 3 $) Prevbus a itions may be used. THIS IS A 4-PART FORM PAGE OF
<br />00550/000717-1350 1
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