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PERMfTTEE NAME/ADDRESS (include Pacil/ry NmndC«onon ijDi$erenq
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2-f6) pl~ 9)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ' ^ ~ ~ TO ~' -
<br />(20.21) 82-231 (2425) R&21) R&29) (30.31)
<br />Form Approved.
<br />~ OMB No. 2040-0004
<br />Approval expires OS-31-98
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<br />NOTE: Read Instructions before completing this form.
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<br />PARAMETER (4&53) (5461 38x5) (46-53) 15.1-61) Fx of TYPE
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<br />NAMEJTITLE PRINCIPAL EXECUTNE OFFICER I CERn
<br />AM FAM FY UNDER PENALTY OF
<br />ILIAR WRH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HER NALLY E7(AMINED AND
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<br />AND BARED ON MV TELEPHONE DATE
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<br />4211':T i!f"CI All))4 INQUIR
<br />THE IN Y OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />FORMATION, I BELIEVE THE SUBMITTED INFORMATION IB TRUE, ~~%%LL ~
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<br />' ACCUR ATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFlCAM '
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<br />~ ~~ ' 070_F'/0_r^.71~ u Zt} 99
<br />.wironment.J ~~.h gar PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br /> POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 1B U.S.C. s 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED 4 1319. (PeMlllaf untler Nese sWlutes may /nclutle fines up m 510,000 entl a
<br />maximum ~mprlsonrrrentdbeMwenBmonths entl5ysars.J OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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<br />EPA Form 332D•7 (OB-95) Previous editions may nol be used. (REPLACES EPA FORM T~40 WHICH MAY NOT BE USED.) ~ ~ T „ ~ ~ ~ i r, ll 1 '+- ~ ~ ,, :I PAGE t OF
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