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<br />NAME .. ~ .... .. ... .. ,
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<br />ADDRESS ~ I fi , ~ ~. E .~-'. ~ d (.') ~ ' T e c + .~ ) '.
<br />~ ]'•JLC: ' ~7 ~r11 J')
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM INPO£$)
<br />DISCHARGE MONITORING REPORT IOMRI
<br />11-161 117-191
<br />'7C"2711 '7~T a
<br />PERMIT NUMBER DISCNMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM '~ TO ` ~ "~ 1
<br />!10.11/ l11-131 114151 !16171 !IB-191 13631/
<br />Form Approved.
<br />.. - ~ r ~ •. ~ - - ObBINo.12040-0004
<br />Fc'r -, r. ., .r1 Approval e~{~iree 05-31-98
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<br />NOTE: Reed Inetructlone belor eomplatlnp this form.
<br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE
<br /> !06'531 !5461) 138-451 !46531 !546/1 EX OF
<br />!31.37)
<br />MALY$IS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-eJ! !64681 168-701
<br />i ~:."iA T'JPA i. SAMPLE y.'F ~R.`•': ~;=?'.`t:~ - .. f ~~
<br />(y$ ,-) MEASUREMENT
<br />7L1 -15 L ~ U ~-' PERMIT ,sk4 trC0 'i4^-C3'. ~. :r MCzf,;w# 'I.S T,(! r IN~^!'/ ;RAR
<br />~F':.J};~'T ~P75, Y.1LU. REQUIREMENT ::L:rt 1nD11 A4^ '3:1TLY tiX M';/L !5DR 'i
<br />:'1... ~, ~ I ti X71; ~,I I ^ f) ° SAMPLE ( :1 3) tifi~«fi.. N fi.;.t~.y ..1.:,.A,t
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<br />77:'i7 1 D '1 PERMIT R°P 9RY 51 P'"ION:~L +~YF'X#¢rr,. Ct'.: to (k#:4 re>;:~:`Y: Y; #'.: ;` 'p ~,'Y ~,'/ 'p.ST]IY
<br />~ii'L'JdtlT oHD:ii 'lEL:)' REQUIREMENT 301+4 AYE SgILY MIR hG? #='~?`
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERnFr UNDER PENUrv of uw TNAr I NAVE PERSONALLr E%AMINEO MD TELEPHONE DATE
<br /> AAI FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MO BARED ON
<br /> MY INQUIRY OF THOSE INDINDUALB IMMEDIATELY RESPONSIBLE FOq
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<br />2icr W rd Mflis OBTNNINO THE INFORMATION, I BEVEVE THE SUBMITTED INFORMATION IS
<br />TRUE
<br />ACCUMTE MD COMPLETE
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<br />SIGNIFCMT PENALTIES FOR SUBMITTING FALSE INFOMIATON
<br />INCLUDING ~~/~
<br />/ (970) 670-2712 8 21 9$
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<br />THE POSSIBILITY OF FNE MD IMPNSO`IMENT. SEE 18 U.S.C. 1 1001 AND J3 SIGNATURE OF PIIINCIPAL EXECUTNE
<br /> U.B.C. 1 1110. lA.Wtl•• uMw elrr mroroa m•Y IrcA.O• AwaW ro 110,000 AREA
<br />TYPED OR PRINTED .nswmurinun Nwrllaomwrr oraw..nemmrA•rq Byeval OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANAIIVN VF ANT VIVLAIIVNS lMSreren0e a//sttsMmsnfs oars/
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<br />EPA Form 3320-1 108-95) Pravloue edltlone may bs used. /REPLACES EPA FORM TAO WNICN MAY NOT BE USED./ 7 n,~ ~ ; / n „ ~, ll ,~ ~ _ ~ ~ I ,r PAGE ~ OF
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