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<br />NATIONAL POLLVTANT DISCHMOE EIIMINATON SYSTEM /NPDE$l
<br />DISCHARGE MONITORING REPORT IDMRI
<br />2-161 l7-191
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM .1 '/ I I ~ TO , I
<br />/10171 /22-231 114351 /16171 l1B-291 !30311
<br />Form Approved.
<br />OMB No. 2040-0004
<br />:: F: I 1 .'. I ' I ' Approve) expires 05.31.98
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<br />-NOTE:' Raed Instruotlau be}aektlnp this form.
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<br />13 Grd On/Y! QUANTRY OR LOADING
<br />11 Grd On/YJ QUANTITY OR CONCENTRATION
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnFr UNDER PENALTY DF uw THAT I NAVE PERSONAUr ExAMINED AND ~ TELEPHONE DATE
<br /> AM fAMIUNI WITH THE INFO RMATION SUBMITTED HEREIN; AND BASED ON
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<br />: MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />,b er mu4run lrw/onwne e/hewA.n emontM rld6 Yee) OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRdersncs d/etfschmenfs here)
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<br />EPA Fam 3320-1 108-961 Preeioue editions mey be used. (REPLACES EPA FORM T40 WHICH MAY N07 BE USEO.) PAGE OF
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