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<br />NATONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />(216/ r1 ~- 9)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ", .w !. TO ~ ~ ~ -, ,
<br />(2421) 122-23) (2425) (2911) (2929) (3W1)
<br />Form Approved.
<br />. , , ., „ OMB No. 2040-0004
<br />Y ~ ^ ~ rl ! Approval expires OS-31-98
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<br />PARAMETER (4653) 54-B7 (38-45) (46-53) (54-81) DC OF TYPE
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EJ(AMINED AND
<br />IN; AND BASED ON MV TELEPHONE DATE
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<br />ichard (kiln INQUIRY OF THOSE INDNIDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON
<br />E THE SUBMITTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE, e
<br />s ACCUAATE AND COMPLETE i AM AWARE THAT TH ERE ARE SIGNIFICAAT
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<br />PENALTIES FOR SUBMITTING FALSE INFORMATIO N
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<br />EPA Form 3320-1 (0&95) Previous editions may not be used. (REPLACES EPA FORM 7~0 WHICH MAY NOT BE USED.) „ n ., ~ ~ r n ~ n u T ~ ^ T ,. ~ ~I PAGE - OF
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