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PERMRTEE NAME/ADDRESS (/nchde Faclliry Nmnellacadon i/DBeeenr)
<br />NAME BOf1IE R~SD~J;CY:S LCI4ITE0
<br />ADDRESSBOYIf- N7. ? ++IN;'
<br />P.O. sox use
<br />FACILITY PAONIA CO 911.25
<br />LOCATIONRU~IlE CD $11120
<br />ATTN; ~ILLI.An A. ~EA9 J7._ RTNV- H~-R
<br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approve0.
<br />DISCHARGE MONITORING REPORT (DMR; -OMB NO. 2040-0004 ~ ~-
<br />(446) (11- B) y r P C R
<br />Approval expires 0&37.9,,
<br />(Sf1A4 V~) ;
<br />PERMIT NUMBER DISCHARGE NUMBER v_ v I N A L D'6L Td
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EJ(AMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BARED ON MV TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (/reference all atracnments nere) )
<br />tiETTLEABLE SOLIDS LIf'T; APPLI55 ONLY IF C=l0YRe24NR P4ECIP ?4:`tT IS Cl.AT"~D. TI' !'LAL~ APP4nY'D fay W~r7.
<br />:'S5 E LRDN LIMEYS WILL ?70~ 3E APPLTNO TO RF;P~RT~?D NFASLT45GF.RT;-S?P 1.4.2, P~ 5 FOA 13NRDFN CF ^9JOF
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