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<br />NAME
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<br />NATIONAL POLLUTANT DISCHAflOE EUMINADON SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT OMR1
<br />1-161 17.19
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />VEAR MO DAY YEAR MO DAV
<br />FROM r ! ; I ~ .1 1 TQ '.~ -i i .i -: 1
<br />lIO-Ill (11-131 /1425/ /16-171 118-191 !36311
<br />Form Approved.
<br />. „. OMB No. 2040-0004
<br />~' ~ ~ ~ ~ ~ ~ ~ Approval eXpiree OS-31.98
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<br />~~ NOTE: ~ Reed Inatructioru 6~1ore. eompletinp thin form.
<br />PARAMETER 13 Grd OnNI QUANTITY OR LOADING to Grd Onhl QUANTITY OR CONCENTRATION NU FREQUENCY SAMPLE
<br /> 118-53! (5461 f38-451 14669 546)/ Df
<br />t31-371 EX
<br />ANALYSIS TVPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS laldJl /64681 (69-70I
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIfY UNDER PENALTY OF L
<br />AM FAMILIAR WITH THE INFO AW THAT I HAVE PERSONALLY E%AMINED AND
<br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br />
<br />' MY INQUIRY Of THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE F'OR
<br />- .. OBTAINING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS -
<br /> TRUE, ACCUMTE AND COMPLETE. I ANI AWME THAT YHERE ME " -"
<br /> SIGNINCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF NNE AND IMPRISONMENT. SEE IB U.S.L. 1 1001 AND J3
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<br />V SIDNATURE OF PRINCIPAL EXECUTNE ~ ~ - '
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<br />rt1.1 MINr IbM IOARIa ,rr.Y lncA.dF lw•.t0ro !10,000
<br />uM er rtrAEnun YrorlFanwter brwwlamonNs wle YarA/ OFFICER OR AUTIIORRED AGENT AREA
<br />CODE NUMBER YEAR MO DAV
<br />GVMNItrv I3 ANU CAr'LNrvX I IVrv ur grvT YIVLM I Wrv0 IrterBYeDCe e/I eneCnmTTS DIle/
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<br />EPA Fam 3320.7 108-96) Previous editions may be used. (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 PAGE OF
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