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PERIAITTEE NAME/ADDRESS (lrVi FreWryNaw/(aonon l/D~1
<br />NAME "" P: .. r r .. ,-. j '
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<br />FACILITY
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<br />NATIONAL POLLUTMT DISCNMGE FLIMINATON SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />11-761 17-I91
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<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM " ' ~~ TO ~ "
<br />176711 l11-73I 111-151 176-17/ 176-79/ 134311
<br />Form Approved.
<br />• ~ ~ ~ ~ ~~ ~ OMB No: 2040-0009r v
<br />Approval expires 05-31-98
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<br />NOTE: Reed Inetructloru before com letinp this lorm.
<br />PARAMETER 13 Grd OnNI QUANTITY OR LOADING /1 Grd OnNI QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> /06-53 /5/-611 !38<51 /16-53 15L611 EX QF P
<br />131371
<br />MALYSIS TV
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsa-ssl /6a-6B1 /69.701
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<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMINED MD
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<br />r MY INQUIRY OF THOSE INDIVIDVALS IMMEDIATELY RESPONSIBLE FOR
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<br />TRUE. ACCUMTE MD COMPLETE. 1 AM AWARE THAT THERE ME
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<br />N. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRSTerence sn ettaehmsnts here!
<br />EPA Form 3320.1 108.86) Previous adlnona may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 .I .. , „- „ _ _ 1 PAGE - OF
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