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PERMITTEE NAME/ADDRESS (IMr4 r,eWry Naw/Lx,Na!/DI])frniH)
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<br />ADDRESS lI~IN::i Lr ? ~ .. , - rRV ;~,I •. 'r
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />II-I61 117-191
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i f _ J TO "~ "1. 'a
<br />(7677/ l17-731 !7475/ l16-171 l79-791 !34371
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<br />.. J,ID
<br />Form Approved.
<br />TnOMBrNo~2040-0004: r~
<br />Approve, expires OS-31-98
<br />NOTE: Reed inetructioru before complatlnp this form.
<br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146-531 !54671 13BL51 /4653 !54611
<br />EX DF
<br />TYP
<br />137-371 ANALrsls E
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s7-s.Tl !54.581 !63701
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<br />NAME(TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF
<br />MILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />RMATION SUBMITTEO HEREIN; AHD BASED ON TELEPHONE DATE
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<br />"I IIS MY INQUIRY OF THOSE INDIVIDUAl4 IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB ~ ~~
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<br />COMMENTS AND EXPLANATION OF ANY VIOLA 7IVN~ lRererence ell ettscnments nere/
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<br />EPA Form 3320-1 108-951 Previous editions mey be used. IREPlACE6 EPA FORM T40 WHICN MAY NOT BE USED.1 ~ n , _ ~ ~,I _ ~,~ ~ ~ _ 1 ~ n n PAGE „ OF
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