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<br />NATONAL POLLUTANT DISCHARGE EDMINATION Sy5TEM (NPOES) FOfm AppfOVed.
<br />DISCHARGE MONITORING REPORT (DMR) OMB NO. 2040-0004
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<br />PERMIT NUMBER DISCHARGE NUMBER - _ {. ~ „:
<br />MONITORING PERIOD i ."'i "," n t : T.:" '. i : ~: L), Ol ] A
<br />YEAR MO DAY YEAR MO DAY
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNat7s/s
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<br />NAME/TRLE PRINCIPAL E%ECUTNE OFFICER I Cerliy untler penalty W law Vlet atla tlocument entl an ettachmenm were - TELEPHONE DATE
<br />preperetl untler ny tlireceon or supervision In ecmrtlance wM a eyslem designed
<br />to assure Vbl quelilletl personnel properly gather end evalueU Ne inlomlellon /r
<br />W. Gordon ;'stare submlaed. Based an rtry Inquiry al the pereon or pereans wno merege the system, ~( ~~sl'i(1~~.-- 910-8'[4-4401 I)1 ~] ~5
<br />or those perecns tllrectly responsible M getl,ering Na Irdormeaon, the Inbrmetlm
<br />President/General Manager submined ls.to Ne best of my knowletlge entl belief, true, accurate, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED fern aware lhal Here ere slgnieurrl penalties ror submining tales inbrmation, OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />Inclutlinp the possibility of fine entl imprisonment br knovnnq violations. CODE
<br />^nnennFnlrc ANn EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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<br />EPA~Form 3320-1 (REV 3/49) Previous a itions may be'used. ' ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - ~~ ~ ~ ~ ~ ~ ~ '. THIS IS A 4PART FORM GE ~: ~ OF
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