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PERMITTEE NAME/ADDRESS{/,/MiaL Fs+l,ryNaWfa•nm yD+d..elq
<br />NAME ("+P _ ~lyl[ .. ~~.. - -
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<br />ADDRESS .ILA '.. ). r 2 ii T ' n r: r ;. .. .: ~ ~
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTMT DIBCNMGE ELIMINATION SYBTEM INPOfS)
<br />DISCHARGE MONITORING REPORT lOMRI
<br />I7-761 II7-191
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<br />PERMIT NUMBER DIBCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM '+ - TO "° ,
<br />176771 172-731 /I4-751 171577/ 178-791 !3631/
<br />Form Approved.
<br />, • ~-0MB~No: 2040-0004
<br />- ~ - ~ .. ~ Approv axgires OS-31-98
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<br />NOTE: Reed Inetruetione befor ~ eom letinp thie form.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING 14 Grd On/yl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> I4E531 I5d-611 I3B-<5l M653 154-51/ EX TYP
<br />137-37) MALVys E
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rea-ear 111'4-1'191 159-701
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<br />C~''!"1ENTS ••: . REQUIREMENT .. 3G`l 't ¢!'{' ';'jv v)+ ^/i •19•; T''I
<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UMDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINEO MD
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE
<br /> OBTNN NUG THE INFORMATION
<br />IIRBELIEVBE THE ESUBMITTED EI~ORMATIOM~B /
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<br />Richard Mllls ,
<br />ACCUMTE Mp COMRETE
<br />TRUE
<br />I AM AWME THAT TNERE ME ,
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<br />SIGNIFICANT PENN
<br />TIES fOR SUBMITTING FALBE INFORMATION
<br />INCLUDING ~. . -~~
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<br />E POBSIBILITY OF RNE MD IMPwBONMENT
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<br />TH BIONATURE Of PRINCIPAL EXECUTNE
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<br />TYPED OR PRINTED eM wmuinvn irrp/efrvrwrr arMMwM enlmnl. erM eY••n.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e// sttechmsnts here!
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<br />EPA Form 3320.1 108-95) Previous edltiona mey bs used. (REPLACE6 EPA FORM T-40 WHICH MAY NOT BE USED.1 ~ n ~ , ~ / ,+ , r I, . ~ _ , ~ , PAGE OF
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