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<br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER ,
<br />I CERTIPP PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED
<br />AND Iri.tirtvFv1;11cTaltlIPZAZINigraiZIEL)YHRIII,NcialiTLIAMR
<br />FOR
<br />THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION
<br />1•71 F l a P VI'V R I I YI ES rgRC COMPLETE. 1,1 I A A L INCLUDING
<br />THE POSSIBILItY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. INFORMATION i 1001 AND
<br />S3 U.B.C. I 13)9. (Penalties under these names may include fines 10 $1
<br />and or nsasistwri Imprisonment of between 6 months and 5 Years.)
<br />:"
<br />'`-'
<br />TELEPHONE
<br />DATE
<br />.
<br />602
<br />.
<br />774-5253,
<br />.
<br />91
<br />04
<br />29
<br />Urjan P . DUrITee -1—
<br />- -
<br />tianager , ' - - - :
<br />EnvirottmeniaAi Studies . . I --
<br />..
<br />' SIGNATURE OF PRINCIPAL EXECU VE
<br />. OFFICER OH ADTHORizED AGENT
<br />AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />. -: TYPED OR PRINTED
<br />PERMITTEE NAM VA S.S (Include • ;
<br />Peaky Nome/Local!. rent)
<br />NAME 2.1, CL A.i. —C (1_ als-iti
<br />. •
<br />ow,* ammo ..arr aroom
<br />FACILI
<br />4.4.. 4.44.4 4444 al+.0 WILW AEI am.. air.
<br />LOCATION - •
<br />• . ,
<br />I 1 .
<br />EPA Form 3320 (Rev. 9 Previous editions may be used.
<br />NATIONAL POLLUTA MARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHA NITORING REPORT (DMR)
<br />(2-1 , (17-19)
<br />PERMIT NUMBER
<br />:FROM FROM
<br />C00000/11
<br />MONITORING PERIOD
<br />1) fi A
<br />DISCHARGE NUMBER
<br />YEAR MO DAY . YEAR MO DAY
<br />TO 9 1 0A
<br />(20-21) (22-23) (24-2 ' .(26-27) (28-29) (30-31)
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />ir NO'CISCHARCE OCCURS REPORT-?00 DISCHARGE". CILE AND GREASE; SEE FOOTNOTE F/.
<br />(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.)
<br />pproved.
<br />o. 2040-0004
<br />F — FINAL Approval expires 6
<br />StORNUATE f)ISCHAf.,C;F,
<br />MINOR (S(ifilt WC) ,`‘tiNTI
<br />NOTE: Read instructions before completing this form.
<br />'
<br />000dP/900610-1402
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