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PERMITTEE NAME/ADDflESS (Include Facility Nmrvl/ncarion ifDiffercnr)
<br />NAME .y,Tr ~~ ~ v1 - T,T ~ -.~.r ~~
<br />ADDRl;$~T1I .'..•; '.~7'•~ ~••^TT' ^~h/'1 ?"
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<br />FACILITY
<br />LOCATION
<br />a. -r: r~:1„ ram ,. -.-;,,,.,, -~,~~AT ~.^';T
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCaA6 GE MONITORING REPORT (DIMR~9)
<br />'7^7271.5q '+~7 ~
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM r- ~~ ~ l TO . a , r r
<br />(3611) (12-331 ('14151 (~5-1]) (39-29) (36JIJ
<br />Fonn Approved.
<br />v A T ., ~ OMB No. 2040-0004
<br />Approval expires 05-31-98
<br />Trv-.' 'r '')
<br />NOTE: Read Instructions before completing this form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERnFY UNDER PENALTY OF L
<br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSO
<br />ATON SUBMITTED HERE NALLY EXAMINED AND
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<br />Richl=rd hllills INOUIRI'OF THOSE INDNIOUAL S IMMEDIATELY RESPON ;
<br />SIBLE FOR OBTAINING
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<br />~rlvironmantz THE INFORMATION, I BELIEV
<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTING E THE SUBMITTED IN
<br />I AM AWARE THAT TH
<br />FALSE INFORMATIO FORMATION IS TRUE,
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<br />70-970-^712
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<br />EPA Form 3320.1 (OBA5) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) .. ~ T II S / 0 7 ~ 1! 1 '- T S „! PAGE ., OF
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