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PERMDTEE NAME/ADDRESS (include Facility NamrJLocmion iJDifferenq
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<br />ADDRESS`!I `i8: Le ~- 1 701!'"'r :' ^"~~A'~ r'(
<br />9100 en~r •;~'~:~,• ..-.f
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
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<br />^)x'17 ]l °.4 (171 A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '-~ "' _rL TO ~' '
<br />(26211 (22-23) p0.251 (26-21i (29291 (3031)
<br />Form Approved.
<br />. ,T T „._ OMB No. 2040-0004
<br />Approval expires 05-31-98
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<br />L'I %rU THR0.T•"`i~ PLA" MEASUREMENT
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<br />NAMFJTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EJ(AMINED AND
<br />IN; AND BASED ON MY
<br />' TELEPHONE DATE
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<br />'~! C!l„ rf( b1f I Is INQUIRY OF THOSE INDMDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMnTED INFORMATON IS TRUE, ~ `
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<br />_YlY(YOll rtOnla~ i "DiIA CPI- ACCURATE AND COMPLETE.
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<br />ALTIES FOR SUBMITRN I AM AWARE THAT THERE ME SIGNIFlCANT
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />.;I; A .F; - ¢ ti 1 /~ 19 n T'. ^T'1 '' „Tr- - r rc` r'1 r1 r /~ .. .,.^^tTT.F 1?';' ., f.. .
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<br />EPA Form 3320.1 (08.85) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) ~ ,~ , ~ A / ~ ~ ~ II , ~_ ~ G ~ ,1 PAGE OF
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