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PERMITTEE NAME/ADDRESS (Ixlyde Facility Nmnr/Lxarion if Dlfferenq
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<br />NATONAL POLLUTANT DISCHARGE EOMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ '~ '~ i ] 1 TO -i q 1 F ~ ^
<br />(2641/ (II-231 (2/-251 (2F21) (2&291 (30.311
<br />Forth Approved.
<br />OMB No. 2040-0004
<br />" +~ T Approval e>~ires OS-31-98
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<br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON M,' 7
<br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING ,
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<br />PENALTES FOR SUBMITTIN ARE THA
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<br />H SIGNATURE OF PRINCIPALE%ECUTIVE 70-q7D-2712 7 2H ~9
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<br />COMMENTS AND EXPLANATION OF ANY VIOLAI wNS (Hererence ell attachments here)
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<br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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