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<br />NATIONAL POLLITTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved.
<br />DISCRARGE MONITORING REPORS:(DMR OMB N0. 2040-0004
<br />rz-+s/ ,t>- nr 3sl r 15 L- n Approval expires 05-31-98
<br />PERMIT NUMBER ~ DISCHARGE NUMBER - t I p l l L 1- T R 1
<br />MONITORING PERIOD ` ' ` C (~ = C C _ i t• t [ L _ C Fr C
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<br />FROM C•I il! TO -~~ ~ C!;Cnf Fit (-_) ~"X
<br />(zo- (zzz3) (a4.zs) lzs~zz! (2&29) (3o-3+) NOTE: Read Instructions before completing this form.
<br /> l3 CeN Onry) QUANTITY OR LOADI Card Onry) QUANTITY OR CONCENTRATION
<br />~ NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61J
<br />' EX OF TYPE
<br />(3237) AVERAGE MAXIMUM
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />J THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, /
<br />. C , ~ ~ ` ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ~ F 7
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<br />~ PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE
<br />1
<br />/ S POSSIBILITY OF FINE AND IMPRISONMENT. SEE 19 U.S.C. 4 1001 AND 33 U.S C. SIGNATURE OF PRINCIPAL E%ECUTIVE ../ 7 _ U/ /X J r,1
<br />TYPED OR PRINTED mer~mum~mprr'sonme ~orl beM1VeenA6umonlhs entl5 years) s up to E+0,000 entl ar OFFICER OR AUTHORIZED AGENT O NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments Here)
<br />r >. ,, :'II'°. u. is `C_-•T 9CiIFY N~~l is ~C LF}'4_ F6IOn iC 1~.."i':h~I FG i:1:;~FA'rCt2-rP:~'1 i.r.•I, i'i IV. CC FTCIY ACFlihi FCn
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<br />EPA Form 3320-T (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) (n I is 7 / C ~ C I 1 1 - 1 t, i a PAOE I OF
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