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PERMFTTEE NAME/ADDPE55 pri,J.Frmry NaWLrauen UDfSiwp
<br />NAME -, ,. I •.
<br />ADDRESS ~ ' ~` ~ - ' '
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISDNMGE ELIMINATON SYSTEM INPOE$) Form Approved.
<br />DISCHARGE MONFfORING REPORT /DMRI r t ~ ~ ~ .OMB No 71040-0004
<br />7-161 (1749 .~,. ~" a
<br />'~ , C'~j / ;, (i ~ ,,) APProvel a~rpirpe OS-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER ~ _ ~ I '
<br />MONITORING PERIOD ~ "
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ! ~ : TO ! .. - - - 1 ~{_
<br />120.171 11T-13) 1Ib751 !1617/ lIB-791 !30.311 NOTE: Read Instructioru bslore eomplstinq this form.
<br />PARAMETER l3 Grd On/yl QUANTITY OR LOADING /I Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> (e5-531 (54671 138-451 145-531 154-611
<br />EX DF
<br />l37-371 MALrSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs7-sal 154581 159-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENIV.TY OF lAW THAT I HAVE PERSONALLY E%AMINED AND 7 -( TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON /
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<br />Mr INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~ / j
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<br />~irh;irl OBTAINING THE INFOIUTATION, I BELIEVE THE SUBMITTED INFORMATION IS /
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<br />S TRUE. ACCUMTE MD COMRETE. I AM AWARE TNAT THERE ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br /> THE POSSIBILITY OF flNE AND IMPRISONMENT. SEE fe U.S.C.
<br />MD 37
<br />' giONATURE OF PRINCIPAL EXECU7NE
<br /> U.S.C. E 131 e. !/
<br />erMeY. urWr eww Nnrre. AvY /xA,W n,.. w ro f IO,OOD
<br />TYPED OR PRINTED eMrmuinun MA+ivw..+r ererr....nsmarm.wsrFr.l OFFICER OR AUTHORIZED AOENT CapE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLA (IONS IRererence en srrscnmsnts Here/
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<br />EPA Form 3320.1 (08.951 Pravloue edlbone mey be used. IREPLACE6 EPA FORM T-40 WNICN MAY NOT BE USED.) / PAGE t OF
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