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PERMfTTEE WAME/ADDRESS (/ncludeFaeiliNNamr/locariun ifDiJjercnq
<br />NAME
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<br />ADDRESS:;:,1-;~`i•?_;.'.i`.~.L: ~'~Z~~~t:. i
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<br />FACILITY
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<br />LOCATION.,
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />' S ~ lam.
<br />PERMIT NUMEIER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ,.+.. ;~} .: ~ , TO ,J ~. -
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE: Read Instructions before comoletina this form_
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO_ FREQUENCY
<br />OF SAy~p~
<br /> IX TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/'TITLE PRINCIPAL EDCECUTIVE OFFICER J certify under penalty of law that this docnmcnt and all attachmrnts were T ELEPHON E DA TE
<br />~~ Q~ ~ pnparod under my direction or sirpcrvistion in accordance with a aystcm designed
<br />to asswro that qualified personnel properly gather and evaluate dre rnfotmation
<br /> submitted. Basal on my inquiry of the person or persons who manage the system,
<br /> or those persons dinrotly responsiblc for gathering the information. the information A ~j w
<br /> submitted is, to the best of my Imowledge and belief, true, accurate, and complete.
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<br />SIGNATURE OF PRINCIPAL CUTIVE ~~ ~
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<br />including the possibility offinc and imprisaorncnt far (mowing violations. OFFICER OR AUTHORIZED AGE R E NUMBER YEAR MO DAY
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<br />EPA Fonn 3320-7 (Rev 3/99) Previous editions may be used. ,~ {. ~ ..,,. •? ~ ^, c~15 ~$ °a..~-ta3Ffr ~~. PAGE 20F
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