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PERMITTEE NAME/ADDRESS pMr4F«WryNa~wwf.«aran pD/8.nnq
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (OMR)
<br />I1-161 17-19
<br />.. PERMIT NUMBER DISCHMGE NUMBEfl
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM 1 1 _' I J :. TO ,. ~ ..._ _ ?
<br />126211 122-231 12425/ 126-171 118-291 /3631)
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<br />Form Approved.
<br />OMB No, 2040-0004.x'
<br />Approval expires OS-31-98
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<br />NOTE: Read Irutruetlons before completing this form.
<br />PARAMETER !3 Csrd Ontyl QUANTITY OR LOADING f4 Grd Only) QUANTRY OR CONCENTRATION NO. HtEOUENCV SAMPLE
<br /> la6531 154511 138-45 !46531 15461
<br />EX of
<br />TYPE
<br />l3Z-371 ANMys13
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l63~691 /64681 /69-701
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERT
<br />AM FA IFY UNDER PENALTY OF
<br />MILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED MID
<br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MV INOVIRY OF THOSE INDINDUMS IMMEDIATELY RESPONSIBLE FOR '
<br />(. ~ ; •. ~ , - ('7 - - OBTNNING THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATON IS -.
<br />' ~- TRUE, ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ARE
<br />INCLUDING
<br />SIONIFCANT PENALTIES FOR SUBMITTING FALSE INFORMATION _ ,
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<br />i ' - -• i THE POSSIBIUTY OF FNE AND IMPRISONMENT. SEE /8 U.S.C. F 1001 AND 33 SIGNATURE Of F'IIINCIPAL EXECUTIVE
<br /> U.S.C. F 1318. d~N14/1 uMM dess moms rMY MCH.vV1 Orvu up ro d 10,000 AREA
<br />TYPED OR PRINTED aaaw muaxmlmpiaavmnr olMerom snandw aM 6Y.a+~l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReJerence a!/attachments halal '
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<br />EPA Form 3320.1 (08.95) Previous editions may be used. (REPLACES EPA FORM T-00 WHICH MAV NOT BE USED.1 _ ~ it ~ F ~ ; :~ , _ t ~ ~. , PAGE OF
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