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PERMITTEE NAME/ADDRESS pndade Foci/ip~ NamrlLOmnon ijD,fferenq
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<br />NATIONAL POLLUTANT DISCHARGE EDMINATION SYSTEM (NPDESJ
<br />DISCHARGE MONITORING REPORT (DMA)
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICeddy antler penalty of law that this document and all attacnmenu were
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<br />i vSIGNATURE OF PRINCIPAL EXECUTIVE ~7n `'T _iJ3•i~ G)y Z _
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<br />inciudin Ne ossibih of nne and im risonmenUOr krwwi vwlations. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
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<br />EPA Form~3320=1 (dE(13/8$) - Prevfous`editionsl flay be used. THIS IS A 4-PART FORM PAGE OF
<br />O~i90/0007i7-1J ;
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