PERMITTEE NAME/ADDRESS n~dr FsNiry NsWfocalm dDlQrnnq
<br />NAME ~PP~:U-, ..... ... LL .Y _ .._-~ .
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<br />FACILITY
<br />LOCATION
<br />NATIDNAL POLLUTMT DISCHMOE ELIMINATON SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT (DMRI
<br />11-I51 117-191
<br />CJO'127151 ^"~
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM '+ "~ TO '! Y ~'
<br />I1PI11 171-731 !14751 116771 179-191 (36311
<br />Form Approved.
<br />• - I - - +~. OMB~Noa 2040-0004
<br />. r ~) APProva) eRPi+s_05-31-98
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<br />PE
<br />137-371 MAyyyg Y
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !eT-sal 164581 !6¢701
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<br />NAMEITITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY FXAMINED MD
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON9BLE FOR
<br />Richard Milis OBTAINING THE INFORMATION, I eEUEVE THE SUBMITTED INFORMATION IS /~~
<br />~
<br /> TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING /
<br />~'K
<br />970 870-2712
<br />8
<br />21
<br />98
<br />environmental il4ana er
<br />9 ,
<br /> THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 13 U.S.C. 1 1001 MD 3] 610NATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. E 1310. !lMWeY. u,l~r rMS mluM. mrY !"rA.W rvws ~ ro t 10,000 AREA
<br />TYPED OR PRINTm .,,eamuinun irNVivnl.Tt oY Mnrwm emanNSrg6Yw..1 OFFICER OR AUiHOR12E0 AOENT CODE NUMEIER YEAR MO DAV
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRetersnCe sl/ ettec/lments natal
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<br />EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ ~ T n • ., ~ I PAGE OF
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