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<br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />NAME '+..l 'IZiN 'V °»C s.SE'L. P'iIN ING
<br />ADDRESS p y ?y
<br />..!(i» 4 ?H .?.1 9y 1 L,. G2^..07
<br />FACILITY
<br />LOCATION C:ij 8046;7
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />037
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM L TO s Lt Lt
<br />Form Approved.
<br />OMB No. 2040-0004
<br />M IN OR
<br />( faUBR JC
<br />F FINA[- f'OUTT
<br />1C?-C;HG TO Kiita.L OX ut #31T'ROLJI . .
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER 'QUANTITY OR LOADING QUALITY OR CONCENTRATION 140• FREOUENCY
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<br />E/TITLE PRINCIPAL EXECUTIVEOFFICER I certify under penalty of law that this document and all attachments were TELEPHON E DATE
<br />NAM prepared under my du,*tfon or supervision in accordance with a system designed
<br />\ ?J to assure that qualified personnel properly gather and evaluate the information
<br />submitted. Based on my inquiry of the person or persons who manage the system,
<br /> responsible for gathering the information, the information
<br />ersons directl
<br />or those
<br />?" - p
<br />y,,
<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE t?V.f? I l
<br />
<br />D e- ax- .
<br />I am aware that there are significant penalties for submitting false information,
<br />AREA
<br />'
<br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations.. OFFICER OR AUTHORIZED AGENT CODE NUMBER . YEAR MQ DAY
<br />COMMENTS AND EXPLANATIUKUF ANY VIULAIIVrva (RVIVFent:e. a,t 41101A000rr10 rrc,cl
<br />iL':u` . # tPi:i: `rl f RW 4+1?eI?,``FD '€ O lfittF", 'ft-l - .?iREXTP EVEN-- - SEE PG. 4, FOR ?! EQNJsF??:,3*"tEi TIS .
<br />GRTRL..sr ^,,111 <.`}G. INSTRU11'MINIS I. C.1-10, PG. 9.
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. < 02:1w1 /{Y is?fs`IA44 -?- f6rm7, PAGE 11OF
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