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PERMITTEE NAME/ADDRESS pr.rb4 F.cmry Ne../L«sum dDIG nw0
<br />NAME [Y DftUj "r .pA VALi.tiT ',11 j, ;"14 P.
<br />ADDRESS 7R~11 `.:i )e.'.
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<br />NATIONK POLLUTMT DISCNMGE EDMINATON SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />l1-I6l l17-191
<br />x]0027157 ^'la
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM "_/ 7_ ': TO ''-~ ^! ~'`4
<br />!16111 l11-131 !14161 !76171 l18-191 !36311
<br />Form Approved.
<br />-• r v c t ^ -I y •• ~- ,. -.OI~IB,No~ 2040-0004 - ,-
<br />/ -_ ., - r ~ - Approval expirec 05-31-98
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<br />PARAMETER !3 Grd On/YI QUANTITY OR LOADING 14 Grd OnIYI QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> /46531 154-611 /38-451 !46531 !54611 DF
<br />131-371 EX
<br />MKY95 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Ie7-s31 !64681 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENKTY OF LAW THAT I HAVE PERSONKLY E%AMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON
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<br />' MY INDUIRY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOR
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<br />C OBTNNING THE INFORMATION, I eEl1EVE THE SUBMITTED INFORMATION IS ~
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<br />Ervircr TRUE, ACCURATE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIRCMT PENKTIES FOR SUBMITTING FKSE INFORMATION
<br />INCLUDING
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<br />]C-H7O-.712
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<br />THE POSSIBILITY OF RNE MD IMPNSONMENT. SEE 18 U.S.C. ! 1001 MD 33 BIONATURE OF PRINCIPAL EXECUTNE . ,
<br /> U.S.C. ! 131 e. IMrlni. undo dwsr moms nrr Nced~ rxw. ~ ro e 10,000 AREA
<br />TYPED OR PRINTED .nswm..tiw.. ewy+a+.n.+raan...n e.~,ww6w..A! OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLA I ION9 lHS/erencs en sffscnmsnrs Aerel
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<br />EPA Form 3320-1 108-951 Prevloue edlDOne may be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.) ~ ~ ~ ..., r ~ ,t „ , r, I ~ 1 ., PAGE - OF
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