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<br />AL POLLUTMT DISCHMOE ELIMINATION SYSTEM (NPDESI Form Approved. i~.. '
<br />DISCHARGE MONITORING REPORT IDMRI ~ ~ OMB No: 0004+
<br />r7-IS/ n-191 PONA 1 D.,('HF . TO leeu~
<br />GB50006 IrOY 1 (SUB JE) Approvel~~l~r~e~ 31-98
<br />PERMIT NUMBER DISCHMGE NUMBER f' - FI FiAL
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<br />MO DAY YEAR MO DAY
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<br />071 7-73/ III-I5/ 176-I7/ 118-29/ /303// NOTE: Reed IneWCtlam belore completing thb }orm.
<br />PARAMETER l3 Grd Onlyl QUA QTY DING /4 Grd Onry/ QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE
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<br />/3I-37/ X MAtYV.s TYPE
<br /> AVERAGE ~XIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 1s7~s91 /5468/ 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY E%AMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFO RMATION SUBMITTED HEREIN: MD BASED ON
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<br />N MY INQUIRY OF TXOSE INDIVIDUALS IMMWIATELY RESPONSIBLE FOR
<br />I BELIEVE THE SUBMITTED INFORMATION IS
<br />OBTNNIMG THE INFOMIATION
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<br />SIGNIFILMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br /> U.S.C. S 1ple. 1PrWU,/ NM,r dNY ,bNr„ +++rY MKAMI fvN, •m ro f 10,000 AREA
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<br />SETILEAdLc iJLI:?S LI!tIT 11AIVED FOR 1J-Tdr 21!-HR PRFCIP EVE;1I :;LtJ7GC'? TO aUfl'EY ]F PRU^° ?: ~;:II['{~*' -y IR
<br />PAFIT I. d. 1. U, PG. 5. STOiiMWATL'R MANAGEMENT PLAN CU° 1-1-3D.
<br />EPA Fpm 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.( I) G 11 / 9 7 0 B 1 0 ~' 1 : r. I• PAGE OF
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