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PERMITTEE NAME/ADDRESS(1,Idi4 Frdlry NrW(nc•nw dObi.wrr)
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<br />NATIONAL POLLUTMT DISCNMOE ELIMINATION SYSTEM INPDES)
<br />DISCHARGE MONITORING REPORT /OMRI
<br />17-161 17-191
<br />~JO'`?71-r r1~n n
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 9' I I° 1 TO I v I! ~+ "~ j
<br />I2P211 111-131 111-351 /16-171 !?8-291 136311
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<br />Form Approved.
<br />,. ,OAQB~No.12040-0004
<br />Approvals expires 05-31-98
<br />NOTE: Reed ImwcUane befor eo pletinp this form.
<br />PARAMETER I3 Grd Ontyl QUANTITY OR LOADING !4 0.rd OnlYl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> l46-531 5461/ I3B-451 !4653 154611 E DF
<br />I3I-371
<br />AVERAGE
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<br />UNITS
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<br />UNITS X
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<br />NAME/TITLE PRINCIPAL E7(ECUTNE OFFICER I CERTIFY UNDER PENALTY OF l AW TNAT I HAVE PERSONALLY EXAMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFOR MATION SUBMITTED HEREIN; MD BASED ON ///,,,
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<br />f' MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS ~ ~
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<br />ACCURATE MD COMRETE. I AM AWME THAT THERE ME ~
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<br />SIONIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF NNE MD IMPRISONMENT. SEE 1B U.S.C. 1 1001 MD 37 ..
<br />61GNATURE OF PRINCIPAL EXECUTIVE
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<br />OFFICER OR AUTHORQED AGSM
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANAIIVN Oh ANY VIOLATIONS (Reference el/attecnmMls ne/e)
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<br />EPA Fwm 3320.1 (08.95) Previous editions may be used. /REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) n „ ~ _ ~ / .1 . ~ ,I ,- T - 1 „ .I PAGE r OF
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