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<br />NAME : L r' r . '- / 1 :. -.. r r r , p .
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTMT DISCNMGE EUMINADOM SYSTEM /NPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />II-161 /7-191
<br />- PERMIT NUMBER DISCHMGE HUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ") O1 ,~ TO on n . TI
<br />Ull7tl 07-031 /74751 l76•a71 178-791 l3Q371
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<br />Form Approved.
<br />.r WOMB ~No.,2040-0004 :. l~
<br />Approved expires 05-31-98
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<br />NOTE: Reed hretructlarre before eompMdnp this form.
<br />PARAMETER !3 Grd Ontyl OUANTRY OR LOADING !4 Grd Ontyl QUANTITY Ofl CONCENTRATION Np. FREOUENCr SAMPLE
<br /> I<5-531 154511 !38-05 !4653 151-5/1
<br />EX OF
<br />TYPE
<br />131-371 "/'urns
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !ea-s]! !64681 /69-)Ol
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTr OF
<br />AM FAMILIM rATM THE INFO LAW THAT I HAVE PERSONALLY E%AMINEO MD
<br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br />
<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~
<br />
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<br />_
<br />nichard t.lills OBTNNINO THE INFORMATION, 1 BEDEVE THE SUBMITTED INFORMATION IS ~ J~jl~
<br /> TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT THERE Mf
<br />SE INFORMATION
<br />INCLUDING
<br />TIES FOR SUBMITTING FN
<br />IFICMT PENN /1 ~~.. ~ A / ///
<br />EnVlronmenta{ tJlanac~er ,
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<br />SIGN
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<br /> THE POSSIBIUTr OF RNE MD IMPRISONMENT. SEE 18 U.S.C. f 1001 MD J7
<br />BIONATURE OF NiiINdPAL EXECUTR/E O.7 71 II 70 O
<br />TYPED OR PRINTED U.S.O. 1 t ]te. IPrWeY• uWr err •r•wr• m.y Ine4,d• Nr• w ro t x0,000
<br />•r,snmri.llm lnpivnws elMwrn e,nmer •M6yrAl OFFlCER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lReterence a// sftecnmsnts oars/ .
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<br />Epp Form 3320-1 108-96) Previous editions may bs used. r (REPLACES EPA FORM T 0 WHICH MAY NOT BE USED.1 ~ ~ 1 ~ ~ /,,, ~ ~„ I, T _ i ~ ~ , PAGE r OF
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