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<br />DISC(H1AR GE MONITORING REPORT (OMR;e)
<br />coJOnozzj oLO e
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM Y' v4 i TO yy uG ~u
<br />(1611) 111-131 24151=T~ TM-1]) (?&1B) (0Wf)
<br /> (3 Card Ony) QUANTITY OR LOADING ~ '(4 Gale Ony) QUANTITY ORC
<br />PARAMETER '
<br />(45-53 (54-6r ~~~ 3Bd5) 4653)
<br />(32-37) AVERAGE MAXIMUM UNITS E MINIMUM AVERAGE MAXIMUM UNITS ~'a-YSIS
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EMAMINED AND TELEPHONE DATE
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<br />S O\. PS AM FAMILIAR WITH THE INFORM
<br />INQUIRY OF THOSE INDMDUAL
<br />THE INFORMATION
<br />1 BELIEV ATION SUBMITTED HEREIN; AND BASED ON MY
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATON IS TRUE,
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<br />ACCUMTE AND COMPLETE. I AM AWARE THAI THERE ARE SIGNIFICANT _
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<br />yy \eV S \ ~ PENALTIES FOR SUBMITTIN
<br />POSSIBILITY OF FlNE AND IMPR G FALSE INFORMATION, INCLUDING THE
<br />ISONMENT. SEE 18 U.S.C. 51001 AND 33 U.S.C.
<br />SIGNATURE OF PRI CIPAL EXECUTIVE
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<br />TYPED PRINTED
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<br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) (IpOi 9f 9~9 ~31i~~y~1 a V PAGE j OF
<br /> Fonn Approvedv ~ Y
<br /> OMB No. 2040-0004
<br />:' I :l U r. Approval expires 0531-9P-~
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<br />ONCENTRATION NO. FREOUENC SAMI
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