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PERMITTEE NAME/ADDRESS 9«A,L F«d~ry N~/L«.uw dDlC..mrl
<br />NAME ~'YPRU' 'i ~ .-[ 'SRI'.
<br />ADDRESS ~ I1V F (i - I - ' , L ! r a '. a
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<br />~r,VGLS~^7' ... 5D1 ~5
<br />FACILITY '
<br />LOCATON
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<br />NATIONAL POLLUTANT DIBCNAflOE ELIMINATION SYSTEM (A/P~E$1
<br />DISCHARGE MONITORING REPORT lOMRI
<br />11-761 /I7-191
<br />PERMIT NUMBER DIBCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM - C TO '~" -'.
<br />11P711 127-731 11<-151 !I6-I71 178-191 13P311
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<br />Form Approved.
<br />,..~oMBJdo~,2040-oooa.. c
<br />Approve! expire? OS-31-98
<br />y NOTE: Raed Inetructlarr befo eom Istlnp this form.
<br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !<Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !<4531 I5<-61/ !3B-<5! I<6-531 15x611 DF
<br />!31.371
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS EX
<br />
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<br />Isq-681 TYPE
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF L
<br />AM FAMIl1M WITH THE INF01 AW THAT I HAVE PERSONALLY E%AMINED AND
<br />1MATION SUBMITTED HEREIN
<br />AND BASED ON TELEPHONE DATE
<br />
<br />:(chard r,nli~S :
<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOq
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS f
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<br />
<br />Environrhental I'r,g!'77nP.r TRUE. ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ARE
<br />SIDNIFICANT PENALTIES FOR SUBMITTING FAISE INFORMATION
<br />INCLUDING ~
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT
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<br />. 810NATURE OF PRINCIPAL E7LECUTNE
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<br />TYPED OR PRINTED ..s«n....im.n lmP/lavlwrr o/an.«e enpndu.a sYe.r,.l OFFICER oR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY
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<br />Epp Form 3320-1 108-951 Prevloue edrtlone mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 n 7 ~,I /,T r r„ ~, -/ - t ^ # .~ PAGE ~ OF
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