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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHMGE EDMINATON SYSTEM /NPDESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />lT-161 117-191
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ L .. TO ' "
<br />1161 /l l21-131 !14151 !16171 l18-191 136311
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<br />Form Approved.
<br />-. ~OfdB.No::2040-0004
<br />Approve expires O5-31-98
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<br />NOTE: Reed inetructiont bafor mpletinp thin }orm.
<br />PARAMETER !3 Grd On/y! QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION NO FREDUENCY SAMPLE
<br /> !06531 /56511 l38-051 /0653 !568/1 OF
<br />131-371
<br />AVERAGE
<br />MA%IMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MA%IMUM
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<br />184-881 TYPE
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<br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENKTY OF LAW THAT 1 HAVE PERBONALLY E%MIINED IWD
<br />MILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
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<br />I .~CI Ij~11-(I I~':I ~~S MY INOUIIIY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE FOR
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<br />F I1t8~ A~u naF TRUE, ACCURATE AND COMRETE. I AM AWARE THAT THERE ARE
<br />SIGNIFICANT PENKTIES FOR SUBMITTING FAISE INFORMATION
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<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS 1Relarence al/ ettschmenrs here)
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<br />Epp Form 3320.1 108-951 Previous editions mey be used. IREPLACEB EPA FORM T40 WHICH MAY NOT BE USED.1 ^ „ T„ ,. /., ; r _ t ~ ~ ~ PAGE t OF
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