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PERMITTEE NAMEIADDRESS (hlclade Facility Name/Location if Different)
<br />NAME[ P:`,
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<br />FACILITY
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 ,
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />CIPAL EXECUTIVE OFFICER I certify under penallyof law that this document and all attachments were TELEPHONE DATE
<br />NAI4iE(i lTLE PRIN prepared under my direction or supervision in accordance with a system designed ?.
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<br />submitted. Rased on my inquiry of the person or persons w
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<br />or those persons directly responsible for gathering the information, the informat
<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE F,? d?
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<br />+-- I am aware that there are significant penalties for submitting false information,
<br />THORIZED AGENT AREA
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<br />TYPED OR PRINTED including the possibility, of fine and imprisonment for knowing violations. OFFICER OR AU CODE NU
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<br />COMMENTS AND EXNLANAI IUN Ul- ANY VIULAI IVI-40 (ri616rtflIGC all auaornncuw uca c?
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.
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