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PERMITTEE NAME/ADDRESS (InNude Faaliry Namr/Lnea,ion fD$erenU
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<br />ADDRESSC r, L,_; K Y ~ I° I `: c,
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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLIrTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCXA6 GE MONITORING REPORT (OMR;9j
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<br />PERMIT NUMBER olscHndcE NuMeER
<br />MONITORING PERIOD
<br />YEAR .MO DAY YEAR MO DAY
<br />FROM il~:.~Q7 O1 TO 00 09 30
<br />fz01n .(2~Y31 (20151 (~6~P]) (26-291 (3031)
<br />Form Approved.
<br />T { OMB No. 2040-0004
<br />Approval expires 05-31-98
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<br />~~ [d Cartl Only) QUANTITY OR CONCENTRATION ~ NO. FREOUENC SAMPLE
<br />PARAMETER (46 53) (54 61) (38 d5) (46-53) (54-61J EX OF TYPE
<br />(3437/ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />f6z~u31 ANaLrsls
<br />(84~68J
<br />69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXPMINED AND ~ t TELEPHONE DATE
<br /> AM FAMILIAR WRH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY gESPONSIBLE FOR OBTAINING I /
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<br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. • `
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<br />ING FALSE INFORMATION, INCLUDING THE
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<br />POSSIDILITY OF FINE AND IMPRISONMENT. SEE 10 U.S C 4 1001 AND 33 U.S.C.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYDED OR PRINTED meximum~mp slpnme ~ol l5emmanGmaonfhs entl5yeersjs up la S10.W0 endw ~ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here)
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<br />EPA Form 3320-7 (08.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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