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<br />N ATIONwL FO LLV Tw NT OIfCMwq GE ELIM INnTION IYSTEM /NPDESI
<br />D ISCNARGE MONITORING REPORT (OMRI
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<br />-ERMIT NUMD[R
<br />MONITORING PERIOD
<br />YEAR MO OAY' YEAR MO OAY
<br />FROM
<br />8 4 0 ° 5y -b 'J
<br />/101/1 /11~1b IN,15R /16171 118:91 /36J71
<br />C i t. G P. Form Approved. f
<br />(S U B R w C ~MBEhj°°?040-0004.
<br />F- F I N A LApproval expires 6-30-91. t
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<br />NOTE: Read instruetlont harfore leting chit form.
<br /> (J Cord Only) OU ANTITY OR LOADING ~qTd Only) QUALITY Ofl CONCENTRATION FREQUENCY
<br />SAM PLE
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<br />Ex DF TYPE
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<br />(3337) wNwlY515 _.r
<br /> AVERAGE MAXIMUM UNIT6 MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
<br />I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PCRSONALLY [RAMINED
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<br />TELEPHONE
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<br /> AND AM FAMILIAR WITH THE rNFORMATION SUBMI
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<br />J t ON MY INQUIRY OF THOSE INq VIOUALS IMMEpATELV RESPONSIBLE FOII
<br />OBTAINING THE MFOIIMATIOY I BELIEVE THE SUBMITTED INFORMATION
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<br />1 J ` / IS iRUC ACCURATE AHO CpAPLETE I wM AWARC TNAi TNERC ARE 51G
<br />NIF ICANT Pf NALTIES FOq SUBMITTING FALSE INFORMATION INCLUDING
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<br />THE POSSIBILrtY OI rINE AND IMPP50NM[NT SE[ IB USC 1 1001 wND
<br />IIlI IM1r
<br />SC 11319
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<br />COMMENT AHO En PLANATION OF ANY VIOLATIONS Inge/tn[[ aq urtutnmrnle nvrl
<br />YHRGITTEt MUST NOTIFY wQCD 30 LAYS PRIOR TG CCM9INiNG DI:iCdARGES-PART I.A.4l PG IV. CORT'11.Y SAMPLi~G FOn
<br />PN, PLOW b OSG ALLOYED DURING PERIODS OF LTD ACCESS; ATTACH STATECdNT TO DtlBI. DETECTION LIMITS-SEE I.F.2.
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<br />0015~/940Y12-1838
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