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PERMRTEE NAME/ADDRESS pnaYdrfse,ryNr/Lxsuen UO/A,rw,U
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<br />NATIOMAI POLLUTANT DISCHMOE ELIMINATION SYSTEM (NPDESI
<br />DISCNARGE MONITORING REPORT lOMRI
<br />11-161 17-I9I
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<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
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<br />l767II l77-731 /11751 176-771 !Ie-191 136311
<br />Form Approved.
<br />.. , - ~ F .-~ y T ~OMB(yo., 2040-0004
<br />r - ,1 , , ; _ 5 Approve expires OS-31-98
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<br />NOTE:' Reed Irnwctloru befori l;ompletinp this Corm.
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<br />NAME/I1TLE PRINCIPAL EXECUTNE OFFICER I OERTI
<br />AM FA FY UNOFA PENALTY OF lAW THAT 1 HAVE PERSONALLY EAAMINED MD
<br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
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<br />F:Ichard tv11115 MY INQUIRY OF THOSE INDIVIDVALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION Is
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<br />EPA Form 3320.1 108-B51 Prevloua edlbons mey ba used. IREPLACEB EPA FORM T40 WHICH MAY NOT BE USED.1 PAGE OF
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