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PERMITTEENAME/A• SSrlr,.Iuit,1,ri1ayNum:.Luwlwnr/lWennr/
<br />NAME
<br />ADDRESS 5OUTHFIELD MINT
<br />FACILITY
<br />LOCATION L L.(JR EN E
<br />.i t) 1) 1 226
<br />NATIONAL POLLUTANT iARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE _sNITORING REPORT (DMR)
<br />t c t
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM tf TO tin, -11 -
<br />1
<br />Yin Approved.
<br />IB No 2040-0004
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<br />QUALITY OR CONCENTRATION NO
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<br />NAME/TITLE PRINCIPAL EiXECUTIV OFFICER I -Mth whler penalty of law that this documcm and all attachtrunta were / TELEPHONE
<br />Ll ,., p?:t•,,,c.! under my direction or suixnisiun to accordance with a system des1611cd ?' /t
<br />??) w ,,.,.hit qualified personnel pwperly gulher and evaluate the information
<br />aubmrncd Based on my inquiry of the person or persons who manage the >ystem,
<br />w lhuse Ixraun> dueatly w>puntble for gadicrtng the udonnauun, the mfunnanon
<br />submntcd s, t.. the he>t of my knowledge end txhcl, true, a-wate, and wmpletc SIGNATURE OF PRINCIPAL EXECUTIVE DATE
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<br />ap to
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<br />/ . I am aware hat there are >,gniticam penalne> for submitting false information'
<br />t OFFICER OR AUTHORIZED AGENT AREA
<br />ER YEAR MO DAY
<br />TYPED OR PRINTED e p s>ibd,ty of fine and unpri,omncm for knowing violation.
<br />indudmg th NUMB
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