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PERMITTEE NAME/ADDRESS prY4 fcWry A'+.!<rancn dDls..nq
<br />NAME Y.tHs C:'~':. :
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<br />NATIONAL POLLUTANT pISCHMOE ELIMINATION SYBTEM INPOESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />!1- l el l7- I91
<br />PERMIT NUMBER DISCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '- ''.G TO - r -
<br />l161I7 l11-131 114151 !16171 118-19/ 13631/
<br />Form Approved.
<br />"} r ? ~ ("•. T'1 • L r IQMBLNo. 2040-0004
<br />(~ ~ _. - p , 1 ApProvel e><pires OS-31-98
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<br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING (4 Grd OnlYl QUANTITY OR CONCENTRATION NO. FneouENCr SAMPLE
<br /> 146531 154-5I1 I3B-~51 !46531 1545/1 DF
<br />I31-371 EX
<br />MALYAS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161-e]! /64681 !e&701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDFR PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN
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<br />MY INQUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE FOR' ~
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<br />EPA Form 3320-1 108-95) Previous editions may be used. /REPLACES EPA FORM T-40 WHICH MAY NOT BE U6ED.1 f ~ I~ „ I, ,i ~ ~ 7 ( .., ~ - . ~ Lr ~ PAGE . OF
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