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<br />LOCATION
<br />NATIONAL POILUTMT DISCNMGE ELIMINATON SYSTEM INPDESJ
<br />DISCHARGE MONITORING REPORT IDMRI
<br />11-161 117-/91
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<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
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<br />U/1Jf1 tlJJ it tle-JFI /96J)I tlB-091 /3Q311
<br />Form Approved.
<br />r .~ ~ ~ T .t ~ - ~ OMB-No: 2040-0004 ,
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<br />/r.l, ., ,.,.1 Approv^'exWree OS-31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
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<br />MILIM WITH THE INFO AW TNAT I HAVE PERSONALLr E%NNINED MD
<br />RMATION SUBMITTED HEREIN; MO GAGED ON TELEPHONE DATE
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<br />kichard Mlll:, MY INOUIRr OF TNOSE INDINDUN.S IMMEDIATELY flESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br /> THE POSSIBIDTr OF FINE MD IMPNSONMENT. SEE 18 U.S.C. ! 1001 MD 3J gIONATURE OF P111NCIPAL EXECUTIVE
<br /> U.S.C. ! 1Gte. IMWer. ,.Mr Nrr mN,lr. n,ry ~Ad/ rPlra W ro t IO,000 AREA
<br />TYPED OR PRINTED eMnmu:+w,r N,pleomrer orArrwwn elmlW Wel+vA! OFflCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence e/I sttecnments Ilerel
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<br />EPA Form 3320-1 108.961 Previous editions mey bs ueed. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ~ n 0 ~ ~ /,~ ~ T ^ n PAGE ~ OF
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