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PERMITTEE NAMEIADDRESSp~drfrebpN~./L«mroe!/Otpaar/
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<br />FACILITY
<br />LOCATION
<br />NATIONM POLLUTANT DISCHAliOE ELIMINATON SYSTEM (NPOESI
<br />DISCHARGE MONITORING REPORT IOMR1
<br />l1-I51 l17-19I
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<br />PERMIT NUMBER DISCHNiGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM' 1 r` 1 l TO ^ ~
<br />124111 l71-131 !14751 /16171 l18-I91 !36311
<br />Form APProved.
<br />~~ ~.~.• -., ." ~..~ OMBrNo.•20460004,
<br />!^I: ,) Approvell expires 05-31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !1 Grd Ontyl QUANTITY OR CONCENTRATION NG FREDUENCY SAMPLE
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<br />131-371 µµY'5 YPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lsl~ssl !84881 !8&701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 CERTIFY UNDER PENALTY OF
<br />AM FAMILIM WITH TIE INFO LAW THAT 1 NAVE PERBONMLY EXAMINED AND
<br />RMATION SUBMITTED HEREIN; AND BASED ON
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<br />/ TELEPHONE DATE
<br /> MY INQUIRY OF THOSE IN DI4IDUALS IMMEDIATELY RESPONABLE FOR /
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<br />AWMIE
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<br />SUBMITTING FKSE INFORMATION
<br />INCLUDING 4//` "
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<br />THE POSSIBNTV OF RNE MID IMPRISONMENT. BEE 18 U.S.C. 1 1001 AND 33 gIONATURE OF PRINCIPAL EXECUTNE Q-~ u P Q II
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<br />TYPED OR PRINTED ,nti nnwrher,nL•ewrawwrt a/Mtw„nsmartlA, rN6Ywa/ OFFICER OR AUTHORI2E0 AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe7erence ee ettecnmenh noel
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<br />EPA Form 3320-1 108-951 Previous editions may bs used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.1 ~ „ i ~ T f„ ~, ~ ~ ~ _ ., r ~ ; PAGE + OF
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