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PERMITTEE NAME/ADDRESS p«i.4 F«dlry Nra.IceeNm l/DIQe.nl)
<br />NAME ::YPn ,,, ';_ f _ ( ..^dI °^~~.
<br />ADDRESS ~ 1 :V s. .` .. ~ ~ ? ;' - ' • ". ''. ' ~ : ^ •,
<br />B IC GSL": 111 C~] .~O1 T7
<br />FACILITY r "
<br />LOCATION
<br />I~TTN: "SO~c47.', r'';L=Yf :'I'PR!sL It"vY
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />l1-161 117-191
<br />-~n7271i4 r)nr q
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM y J TO ~'
<br />1161 Il 111-131 114151 176771 116-191 136311
<br />Form Approved.
<br />.• T •; r 1 r ~ _ •; n ~ ^. ~OIdB)I~o,t 2040-0004....
<br />-,. ;,,~~ APProve, eX{~irPs 05-31-98
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<br />A NOTE: Reed Inetructioru belors complatlnp this Corm.
<br />PARAMETER 13 Grd Onlvl QUANTITY OR LOADING /I Grd On/Yl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146531 I5d-611 138-051 !4653 154611
<br />EX of
<br />TYPE
<br />131-371 ANALrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163631 184681 !63701
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<br />NAME/T'ITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA Fr UNDER PENALTr OF LAW THAT I HAVE PERSONALLY EXAMINED MD
<br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> Mr INQUIRY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS '-~ ~.
<br />/~
<br />kicflard ~4IlIs TRUE, ACCUMTE MO COMRETE. I AM AWME TNAT TNERE ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING (/~~ ~~ '
<br />
<br />F_nvironment:,l r.i~ pacer ,
<br />THEP055181LITYOFFINEMDIMPNSONMENT.5EE18U.S.C.11001MD]]
<br />SIONATUREOFPRINCIPALEXECUTNE 97O 3JO-371 ~ ~ ~ 7[1
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<br />NUMBER
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<br />TYPED OR PRINTED ms>muiw.rr bp/ervnenf efertwwl a mannNW 6 f.rF.l OFFICER oR AUTHORIZED AOENi CODE AY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/efence s/I ettschments hsfel
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<br />Epp Fofm 3320-1 10&-951 Previous editions mey bs used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 n r T ~ =1'/,) ° (' 11 ^ ~ - ] ~ ^ ~ PAGE - OF
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