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PERMITTEE NAME/ADDRESS pnd:4 imWryNa./Lo[allen gDlp....q
<br />NAME ° Y O ~' I ~ •~ - •- ~
<br />ADDRESS "• I N F i r ,` _ ~ _ +. ~
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<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHMOE EUMINATON SYSTEM lNPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />IT-76I l17-191
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ r -' ,.. ) TO ' ~ ~' , ~'
<br />!7677/ !TI-T3/ 124-751 IT6-T7/ 116-T9/ 1343!/
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<br />Form Approved.
<br />..,,OMB.Non2040-000,4 ;
<br />Approve` expires 05-31-98
<br />1 .. 1
<br />NOTE: Read Inetruwiwr before complstinp this loan.
<br />PARAMETER !3 Grd On/Yl QUANTITY OR LOADING /4 Card OnlYl GUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> 146-531 !54611 !36-151 !46531 15b611 EX DF P
<br />l3T-37/
<br />ANALYSIS TY
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /61.69! 164681 169-701
<br />.G"CUC1`Tl`T°v SAMPLE
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<br />r'L:)E:X'. - . ` , ~ ~ ' L REQVIREMENT . ~ ,- Tv'rT ~~/. •;T
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CFATIFY UNDER PENALTY OF L AW THAT I HAVE PERSONALLY E%M11NED AND /r TELEPHONE DATE
<br /> ABI FMIIUAR WITH THE INFO RMATION SUBMITTED HEREIN: MID BASED ON ~,
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<br />raChard P.IIii~ MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOB
<br />OBTMNIND THE INFORMA710N
<br />I BELIEVE THE SUBMITTED INFORMATION IS /
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<br />TYPED OR PRINTED ra•rmuhnan inFdaomlrrt•/Mrwwn6mmMa rg6Era/ OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANr vloiAl Ions lRererence an arrscnmenu nerel
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<br />EPA Fwm 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) n ,~ 1 ~ ~ /„ , P,1 ~~., _ 1 n ~ ~ PAGE 1 OF
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