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PERMITTEE NAME/ADDRESS (Include Facihry Name/Locution ifDiBcrenU
<br />NAME
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<br />ADDRESS~I PiE~ 1, .iS3 `.GGlil, %. ~,CggA4 PK
<br />91UU EAST :I :1 !'.P.AI CI:;~LC
<br />FACILITYENGL:;'a00C CO UU1S5
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2.161 Qr- 91
<br />rn!1n711 SLL Rn'
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM U U U U 1 TO U U 0/ 3 1
<br />(20.21) 122-43) (24251 (26~2rJ (1849) (3091)
<br />Form Approved.
<br />.+,0 `` OMB No. 2040-0004
<br />Approval expires OS-31-98
<br />(SUaN hY)
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<br />(69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF IAW THAT I HAVE PERSONALLY EXAMINED AND
<br />NFORMATI
<br />BMITTED HEREIN
<br />AND BASED ON MV
<br />E TELEPHONE DATE
<br />
<br />Richard PJ1(IIS ;
<br />AM FAMILIAR WITH TH
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<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~
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<br />nvironmental Manager
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE,
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />97II-87O-2712
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<br />PENALTIES FOR SUBMITTING FALSE INFORMA
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<br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE IB U.S C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />,L;);:{tiATF: LIMITS FOd T:iS, InCN G SET"fLEABLS SULIDS (LOC 'C') A?PLY C!rLY IF <= 10-Yn, ?4-HF PSECIP ='JE'ST
<br />,5 CLAI1~t?7. SE6 L.A.2, PG LH, FOR -tUF.DEN OF P%04F RE~UIHECENTS. CIL G45AS~-3c'E FOOT.4^TE F/, 'eG 2.
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<br />EPA Form 3320'1(OR-95)~~ Previous editions may ntit be used? r~ -(REPLACES EPA FORM~T~O WHICH MAY NOT BE USED.) U C 07 2 / 0 0 0 4 v 5 - 1 : O 1 PAGE z OF
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