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PERYITTEE NAYEIAQ•"r$S (/nrlude
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<br />NAME ,_)1_, (1 C~IG I. C(11^, k'_!IY_ ___ ___
<br />ADDRESS ~: (1LUwYO 71TY,~ _________
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<br />FACILITY _ _ _ _ _ _ __ _ _ ~ _ _ _ __
<br />LOCATION__ ~~~___ ~-__ ___
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<br />NATIONAL POLLUTAN~~ ~MARGE ELIMINATION SYSTEM /NPDES/
<br />DISCHARI dNITORING REPORT /DMR)
<br />/7-16/ ~ 117-191
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<br />PERMI7 NUMBER DISCHARGE NUMBER
<br />_ MONITORING PERIOD
<br />,~ =~ ` YEAR MO DAY YEAR MO DAV
<br />FROM TO i
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE P ERSONALLY E%AMINED ~ ~
<br />,; TELEPHONE DATE
<br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTE D HEREIN; AND BASED ~. /
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<br />~ ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATE LY RESPONSIBLE FOR
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<br />" OBTAINING THE INFORMATION. I BELIEVE THE SUB
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<br />VI
<br />LAND~ENVIkONMENTAL ANFAIII 6 BMITTING
<br />FA SE
<br />NFORMATION
<br />NC
<br />U D
<br />NG
<br />'NIFICANT
<br />PENA TIE6
<br />FOR 3O3 HZ/i~GJ7SI OA IG I Z
<br />' :,. THE POSSIBILITY OF FINE ANO IMPRISONMENT. SEE 18 U.S.C. { 1001 AND SIGNATURE OF PRINCIPAL E%ECUTIVE
<br />
<br />TYPED OR PRINTED 33 U.S.C. 1 1378. lPenalria under rhne sralulu maY iurludr Jlw uP ra 7/0.000
<br />andor mar,mum impraonmrnro/6rn,rsn6manrAr and Jyrarz.l
<br />OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO.
<br />DAY
<br />COMMENT ANO EXPLANATION OF ANY VIOLA 710NS (Rq/tnenCt all a(laMmMpAen/ i
<br />I.: ~JIL v 6hFA.SB--_ik4 F'OUTGuLt F/ j•1 PNP: i'F.:1SIT. :icTfl.F:Si+LL'' :;OLID~ TCSI' 'n'Fa,~i1LRI:J ONLY IF <= 10-Yh~ ?~1-11F
<br />f=~( LL' iSVF'NT CLF.I"`'U. I[ (:L.AII'I r1e'PtOY;.U H'f 'd~1CJ, T:;~ l; LnJ;i Lir![1'.i dl 1. i. till':' ''!' .4?6'L[t;D TJ d'i'Uit'l'F.~
<br />EPA'Form T BY.9-B8) V/OU a t10 emey ue .- ( E AFO JB WNICM YAY NOT BE USED.) PAGE OF
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