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PERMITTEE NAME/ADDRESS pntl,d. Fsdiry NawyLecanon dDlQ.nnO
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<br />NATIONAL POLLUTANT DISCHAAOE ELIMINATON SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (DMR)
<br />I1-161 117-I9I
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM 'a ! TO "' I t
<br />170.711 177-731 !74751 !16771 178-791 /30.311
<br />Form Approved.
<br />E .' p .- 1 ^ Y r. TQMBt110,-2040. 0004 - .r
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<br />NOTE: Reed Inetructione before eomPlatinp this form.
<br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING /4 Grd Onryl QUANTITY OR CONCENTRATION NQ FREOUENCr SAMPLE
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<br />37 !46531 /5481 /38451 14653 !5481/ OF
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is]-s]1 /8¢88/ !8¢701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />MILIAR WITH THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUN.S IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />IFls
<br />TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE AIiE ~
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<br /> SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />Fnvironment~l Ii~Ail^~]F'Y ,
<br />THE POSSIBILITY OFRNEANDIMPRISONMENT
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<br />EPA Form 3320.1 108-%) Previous adition5 mey be used. (REPLACES EPA FORM Td0 WHICH MAV NOT'BE USED.1 n r „ 7 ~ .1 C y ,t _ _ 1 „ .I „ PAGE r OF
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