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PERMITTEE NAME/ADDRESS (1»rludeFaciliryNmne/Gocarion yDgwmq
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<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) FOmI AppmVBd.
<br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004
<br />Approval expires OS-31-98
<br />PERMIT NUMBER DISCHARGE NUMBER ,. _ ~ . ~ i 7,~ , ~
<br />MONITORING PERIOD "' ^^"~ "O ^i;Tn^. rnrp-•~
<br />YEAR MO DAY YEAR MO DAY
<br />FROM n 'I l ".~ 7 1 TO n ., T f. ~ 1 ,r ..: .- ~ . _ ^.-. , . ' -- T ,; ,r ..
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<br />' (3 Card Onty) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (48-53) 54-61 3B<5 (46-53) 54-81 EX OF TYPE
<br />~~~n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AI4
<br />AL~S
<br /> ~~) ~ 69-70
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<br />NAME/TITIE PRINCIPAL IXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMIUM WITH THE INFORM ATION SUBMnTED HEREIN; AND 945ED ON MY
<br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br /> THE INFORMATION, I BELIEV E THE SUBMRIED INFORMATION IS TRUE, ~ '' ~
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<br />' ACCURATE AND COMPLETE.
<br />PENALTIES FOR
<br />BMITPN I AM AWARE THAT THERE ARE SIGNIFlCANT
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<br />INCLUDING THE ~~
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<br />POSSIBILITY OF FlNE AND IMPRSONMEM. SEE 1B U.S.C. 4 1001 AND 33 U.S.C.
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<br />' 'SIGNATURE OF PRINCIPAL EXECUTIVE 9' ~~ g~ ~-Z~ T Z 1 1 z (i 99
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<br />b OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here)
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<br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE OF
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