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PERMITTEE NAME/ADDRESS (lMrirrWyNr/Lecenaw UDIp...nq
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<br />ADDRESS ~ ~ I R F: ~ 1 F .' - ~ 1 - r F ^ h'^~ ~ N ', r
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLU7MT DISCNMOE ELIMINATION SYSTEM (NPOES/
<br />DISCHARGE MONITORING REPORT IDMRI
<br />(1-161 117-191
<br />. ~I .i)~~i14 Q17 ~
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '+ + '1G ' 1 TO `~" ' I ~- "'
<br />170-7I1 112-131 11475/ 13E271 128-791 134311
<br />Form Approved.
<br />•r . \I .- E .• ~ - v !-,1 . p D LOMB,No,. 2040-0004 -.
<br />(,_ _ _ ~ ~ Approve4 expifeB 05-31-98
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<br />NOTE: Raed Inetructlone before completing thb farm.
<br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !4 Ord Onlyl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE
<br /> l4b531 15Q-611 13Bd51 144531 154611 EX K E
<br />137.371 YSIS
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<br />UM UNITS !s7-sal f5I-691 6
<br />9-701
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<br />NAME/TITIE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD r ~ - TELEPHONE DATE
<br /> AM FA MILIM WITH THE INFO RMATION SUBMITTED HEREIN; MD BASED ON /;
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />i~IGI;.~YI r ilI_r OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ /,
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<br />i' TRUE. ACCUMTE MD COMRETE. I AM AWME THAT THERE ME
<br />SIGNIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCIUDINO '~
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<br />THE POSSIBILITY OF RME MD IMPIIISONMENT. SEE 19 U.S.C. ! 1001 MD 3]
<br />SIGNATURE Of PRINCIPAL EXECUTIVE -
<br /> U.S.C. 1 1 ] f e. IMWtlr~ rdr IMr rblvhr nNY lncAr/N rxw+ M~ ro t IO,OOtI AREA
<br />TYPED OR PRINTED mdnmrimin MFdaawwrr olbfwwremmdu ~rM 6Yrn.1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF AN7 VIULA I I VND' IrFSrerence en srrecnmsnrs oars/
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<br />EPA Form 3320-t (08.95) Prevloue edluone mey be used. /REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ,1„ ~ G„ T r„ ,\ ~ _ 1 ~ , \ PAGE T OF
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