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PERMITTEE NAME/ADDRESS ff~dvbisWryNa/lasuw UD~inu)
<br />NAME ~y~ ~' ~' ~ f' ° CL rte: ~~
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTMT DIBCHMGE ELIMINATION SYSTEM 11VP0£$l
<br />DISCHARGE MONITORING REPORT lOMR)
<br />I1-I6I I7-191
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERI00
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '+ i n; ~+ TO r1 r, n T ~t7
<br />0(1911 l11-0.?I tl4151 116.171 118-191 1363/)
<br />Form Approved.
<br />w r •: r ? ~ ^..~ V ... _ ,. -.ON~B~No.,2040-0004. ;
<br />Approve4 expires OS-31-98
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<br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !4 Grd OnlYl QUANTITY OR CONCENTRATION NO FREDUENC'Y SAMPLE
<br /> lIG531 (5461 138-151 146-531 151-6// EX TYPE
<br />131-371 µN.YSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 169-e~1 1
<br />61.661 169-7
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UHDER PENALTY OF L
<br />AM FAMILIM N'ITN THE INFO AW THAT I HAVE PERSOMN.LV E%AMINED MD
<br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP
<br /> OBTNNINO THE INFORMATION, 1 eEUEVE THE SUBMITTED INFORMATION IS
<br />f t TRUE, ACCUMTE MD COMRETE. I AAI AWME THAT THERE ME
<br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />RIC{:i Y(i !L,Si{{e ,
<br /> THE POSSIBILITY OF RNE MD IMPNSOMMENT. SEE 18 U.S.C. F 1001 MD ]] SIGNATURE OF PIIINCIPAL EXECUTIVE O n_ 1 . 1 I 1 o en
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<br />COMMENTS AND EXPLANATION OF ANY vIVLA I wlvs IlEarerencs sn srrscnmanrs oars/
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