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PERMITTEE NAME/ADDRESS (l Y4 ErIGryN~//faanm IlDrpe..q
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DI9CHMDE ELIMINATION SYBTEM (NPDESI
<br />DISCHARGE MONRORING REPORT IOMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM cif. ) L TO 'lal -1"
<br />116111 l11-131 !14151 116-171 118-191 !36317
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<br />Form Approved.
<br />~n ~OFS1BlNo:12040-0004F it
<br />Approval, e><prtss 031-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING l6 0.rd Ontyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46531 15b511 l38-651 14653 154-611 EX QF TYPE
<br />131-371 ANALrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.691 164-551 rss-Iw
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT 1 HAVE PER90NALLY E%AMINED AND TELEPHONE DATE
<br /> AM FA MILIAR WITH THE INFORMATION 9UBMITTEO HEREIN; AND BASED ON /\
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<br />1~~ MY INQUIRY OF TH09E INDINDUALS IMMEDIATELY RE9PONSIBLE FOR
<br />OBTNNINO THE INFORMATION, I eEUEVE THE SUBMITTED INFORMATION 19 / / J'/ ~~
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<br />Fnvlrnnmental ;IAcnan~r
<br />TRUE. ACCURATE AND COMRETE. 1 AM AWARE THAT THERE ARE
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<br />THE P0591BIUTY OF RNE AND IMPRISONMENT. SEE 1B U.9.C. 1 1001 AND 93 SIGNATURE OF PIIINCIPAL EXECUTNE
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<br />COMMEN TS ANU EXPLANA l IVN Vr Arv T XIULA I IUrvJ I/rOB/BnC1 e// effeClllne/I E3 ne/i/
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<br />EPA Form 3320-1 108-951 Prevloue edmone may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 „ n ~„ t / ., a ^,I , ~ _ 1 n - n PAGE , OF
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