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PERMITTEENAMFJAD4RIESS (71c" Fee NaaWLoeaftan I/D(fwwfl
<br />NAME LU Tf, ENI .!`RC9?Y INN.
<br />ADDRESS DUNCE M11NE
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<br />FACILITY MI N
<br />LOCATIONg•»f 6A v,
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO: D Y YEAR CII D
<br />FROM TO
<br />Form Approved.
<br />"flit OMB No. 2040-0004
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<br />NOTE: Read Instructions before completing this form.
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<br />EX FREOUENCY
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<br />NCIPAL EXECUTIVE OFFICER
<br />' t certny under penalty o law that this document and all attachments were TELEPHON E DATE
<br />TITLE PRI
<br />NAME/ prepared under my direction or supervMon In accordance with a system designed
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<br />to assure that qualified personnel property gather and evaluate the Information
<br />submitted. Based on my Inquiry of the person or persons who manage the system, ,
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<br />?"?[ or those persons directly responsible for gathering the Information, the Information G/
<br /> submitted ts, to the best or my knowledge and belief, true, accurate, and complete.
<br /> I am aware that there are si
<br />nificant
<br />enalties for
<br />fain Informati
<br />bmittin 81 ATURE INCIPAL EXECUTIVE
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<br />PED OR PRINTED Including the possibility of fine and Imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COM?u?ENTS AND EXPLANATION yr ANT vwLn I Ives (K ertrnce sii af?recnmonrs Vii;. p _.? l E ? k- R 'R d I r"R X id A t ? LO, N'a A .U,•'?
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. i) " T . V91 ' (A S(6 8 4 6djt' fair.'. PAGE OF
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