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PERMITTEE NAME/ADDRESS (7nclade Faciliry N~/rM'^rion ijDifferem)
<br />NAME
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<br />FACILITY PAOhIA CO HIN23
<br />LOCATION
<br />i501LE CG 91428
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<br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FORn AppfOVed.
<br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004
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<br />Approval expires 05~T-98 I
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<br />NAMElTITLE PRINCIPAL IXECUTNE OFFCER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WRH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MV
<br /> INQUIRY OF THOSE INDNIDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING
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