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<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
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<br />' PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM n ~ (J7 ^ 1- TO S J,1 s J.
<br />!16111 !]]-131 /14]51 /]6-]71 tlH-]91 136311
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<br />Form Approved. /
<br />- ,OMB No.~2040-0004
<br />''' Approval expires 05-31-98,
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<br />NOTE: ~ peed Imtructlone before Domplatlny this form.
<br />PARAMETER !3 Grd On1Yl QUANTITY OR LOADING !I Grd On1Yl QUANTITY OR CONCENTRATION ND, FREOUENCr SAMPLE
<br /> 146-531 !5Q-el1 /38-45 !46-53 /51-51 OF
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m]-s.Tl !64681 I6g7ol
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERTIFr UNDER PENN.TV OF uW TNAT I NAVE PERSO
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED H NALLr ExAMINEO AND
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<br />MD BASED ON TELEPHONE DATE
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<br />Mr INOUIRr OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />I BEl1EVE THE SUBMITTED INFORMATION 19
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<br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIFICMT PENN
<br />TIES FOR SUBMITTING FALSE INFORMATION
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<br />THE POSSIBILITY OF RNE MD IMP11150NMENT. SEE 18 U.S.L. E 1001 MD 39 / ~"~~
<br />eIONATURE OF PRINCIPAL EXECUTIVE / (~'U j~J-/; ~Q~ ~r ~ r/~ OZ
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<br />TYPED OR PRINTED U.S.C. E [ 910. lANrMrr u,W rMw mums muY hcN.tl~ fxwa tq ro FIO,OpO
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<br />EPA Form 3320.1 108.951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.( _ PAGE OF
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