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PERMITTEE NAMEIADDRE55 pMdJ. FsmryNsN/Lecano. pn~..v.e
<br />NAME ^v V'i0• „ . .. ~ T . .. .. L ... .
<br />ADDRESS ).: ?{ E' S i r ... ~ ~ _ , .. r >- .I -, r
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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTMT DISCNMOE ELIMINATION SYSTEM INPDfSI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />7-161 /I7-131
<br />C797271~4 ~~r• !I
<br />PERMIT NUMRER DISCNMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM Yh ,., .IL TO Vy t t
<br />l1Q711 /72-731 !74151 !76171 178-791 l3P31/
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<br />Form Approved.
<br />~,.nOMB.No.)2040-0004.. ~.
<br />Approve{ expires 0531-98
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<br />NOTE: Read inetruelioru bat co IetinO this form.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING (4 Grd Onhl QUANTITY OR CONCENTRATION ND FREOVENCY SAMPLE
<br /> !46531 !5<-dll !38-45 !46531 154611 EX DF TYPE
<br />131-371 MALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS fs7-e3I /8468) !5370/
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<br /> MEASUREMENT
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<br />NAME/EITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD
<br />AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BARED ON TELEPHONE DATE
<br />
<br />Rfcharci A11II5 MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFOM/ATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />TRVE. ACCURATE MD COM0.ETE. I AM AWME THAT THERE ME
<br />SIGNIFICMT PENALTIES FOR SUBMITTINQ FALSE INFORMATION
<br />INCLUDING l
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<br />970 B7O-2712
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<br />THE POSSIBILITY OF RNE MID IMPNSONMFNT. SEE 1B U.S.C. f 1001 MD 33 SIGNATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. 1 l 31 e. f/11nY14. u.er N.r mnma mrY ~. ln.a w ro S IO.ODO AREA
<br />TYPED OR PRINTED rNa-nr.irx.rl MpfaemwrNWbfwwnemonMa rW6 yeva/ OFFICER OR AUTHORREO AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS Irrerersncs en errecnmenrs Here!
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<br />EPA Form 3320.1 108.951 Previous editions mey be used. IREPLACE6 EPA FORM T-40 WHICH MAY NOT BE USED.) ~ I ~ . ~ ~ ~ _. PAGE OF
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