PERMRTEE NAME/ADDRESS p~4FrdIgNaWLoclllan l/D1pmw9
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<br />FACILITY
<br />LOCATION
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<br />NATIONK POLLUTMT DISCHMOE ELIMINATION SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />lI-I6I /17-791
<br />::)n'1271i7 ^15
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM ~ ' 1 TO ' I 1 ~ ; _
<br />1161/1 l11-131 111-151 116171 /IB-191 !30311
<br />Form Approved.
<br />•• T •~ ^ p n ., ~~, ~~ T -, OI;IB-No. 2040-0004
<br />{ ~ ,, T, „ ^ r ,/~ Approve! expires 05-31-98
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<br />NOTE: Raad Inetrucdone bsloro complatinp thu farm.
<br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING !4 Grd On1Y1 QUANTITY OR CONCENTRATION NU FREQUENCY SAMPLE
<br /> 14653 l5bs11 I3B-<5l !16531 151511 DF
<br />131-371
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<br />169-701
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<br />NAMElfITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENKTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD
<br />MILIM WITN THE INFORMATION SUBMITTED HEREIN; MD BMED ON TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOR
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<br />ALCUMTE MD COMPLETE
<br />I AM AWME THAT THERE ME _
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<br />AGNIFCMT PENKTIES FOR 9UBMITTINO FKSE INFORMATION
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