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<br />NATIONK POLLUTMT DIBONMGE ELIMINATION SYSTEM (NPOE$) Form Approved.
<br />DISCHARGE MONITORING REPORT /DMRI ^ v ., ^ ,. _ r, T c. .- ~. TOMB No^2040-0004
<br />11-161 l17-191 ~ "T - ~ ~
<br />„ ^ ., ~ ^ ~ . ~ ,t ^ ~ , (~.... ~ ~ Approval e>tPiree OS-31-98
<br />^ PERMIT NUMBER DISCNMGE NUMBER _ ~ r ., • ,
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
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<br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !I Grd Onryl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !f7-fa! lµ581 /5&701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER i~E FAMILIIM WITHNTNE (INFO MATIONTSUBMITTPEOBHEREINY MDD BASEDMON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR '
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<br />':ill OBTNNING THE INFORMATION, I BELIEVE THE SVBMITTED INFORMATION IS
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<br />TRUE. ACCUMTE MD COM0.ETE. I AM AWME THAT
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<br />TYPED OR PRINTED Wwmuimin Erlpdotnwnr a/Mrwwnfinendra rNfrFera/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/ersncf se stteenmen/s Afrfl
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<br />EPA Form 3320.1 108-951 Previous editions may b6 used. - IREPLACEb EPA FORM T~0 WHICH MAV NO BE U6ED.) t` ^ ~ + .a ~ O ~~ P fl ^ ^ - 1`i 7 !' PAGE
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