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<br />NATIONAL POLLUTANT DISOHARGE ELIMINATON SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />lI-151 17-I91
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM 1'I :_ TO ~ ~~ 1
<br />II6171 l12-T3/ !14151 !1617/ !IB-I9/ !3637/
<br />Form ADProved.
<br />c~~ -• y s •.; ^n •~ ~ ~ -:~ OMB-No: 2040-0004 -
<br />! c I I -, o • •:) Approval e~piree OS-31-98
<br />T•T"`EECEIVED
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<br />PARAMETER l3 Grd Onlrl QUANTITY OR LOADING 11 Grd OnIYI QUANTITY OR CONCENTRATION ' ' ~` u FREDUENCY SAMPLE
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<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I cERTI
<br />AM FA Fr UNDER PENALTr oP
<br />MILIAR WITH THE INFO uw THAT I NAVE PERSONALLr ExAMINED AND
<br />RMATION SUBMITTED HEREIN: AND BASED ON TELEPHONE DATE
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<br />MY INOUIRr OF THOSE IXDINDUALS IMMEDIATELr RESPONSIBLE FOR _
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<br />' OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS ~ . ~ Y /~
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<br />EPA Form 3320-T 108-s51 Previous editions may be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) r n r+ T /~ (•l~ ^ -+_ / n PAGE ~ OF
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