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PERMITTEE NAMFJADDRESS (TncFeTe Fac1liry Nmne/Lomhon ijDiBermr)
<br />NAME EOWLr. l,tir:i~(_r: .SPI"FC
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<br />NATIONAL POLLIfTANT ON'CFIARGE ELMIWLTION aYSTEM (NPUES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMR~ OMB NO. 2040-0004
<br />Approval expires 0531-98
<br />PERMIT NUMBER DISCHAAGE NUMBER F_ r•\ P L I L I 1 A
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<br />NAMEJTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UN ER PENALTY OF L
<br />AM FAMILIAR ITH THE INFORM AW THAT I HAVE PERSO
<br />ATION SUBMIllEO HERE NALLY E%AMINED AND
<br />IN
<br />AND BASED ON MY TELEPHONE
<br />. DATE
<br /> INQUIRY OF THOSE WDNIDUAL ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br /> THE INFORR7,gTION, I BELIEVE THE SUBMITTED INFORMATION I$ TRUE, ^
<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFlCAM' ~
<br />-~ ice, (t
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<br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE I
<br />,
<br />~~~ (I ) (, POSSIBILITY OF FINE ANO IMPRI
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<br />4 73t e
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<br />d SONMEM. SEE 1e U.S.C. 41001 AND 33 U.S.C.
<br />I SIGNATURE OF PRINCIPAL EXECUTIVE ' -' I ~- ~ ~
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<br />TYPED OR PRINTED . (
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<br />OFFICER 011 AUTHORIZED AGENT ,,,,,,~
<br />NUMBER ,
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aelerence all etfachmenLy here)
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<br />EPA Fonn 332o-1 (0&95) Previous editions may not be used. (REPLACES EPA FORM T-a0 WHICH MAY NOT BE USED.) C C C I ~ / i i C l I L - 1 ` i E PAGE I OF
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