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PERMITTEE NAME/ADDRESS pwWb FSd,ryNar/laenw UDtf)ssp
<br />NAME _ y ' ~ ~ _ ~ _ _
<br />ADDRESS Si `.~ '.s Ji ~^,u'.s ..~-`.4 ~. .v
<br />Dip'? •.''.r ^ .. T':. ^'.? CI%C L.,
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNMOE ELIMINATION SYSTEM lNPQf$)
<br />DISCHARGE MONITORING REPORT IOMRI
<br />I7-161 l17-191
<br />C~0^:71ia n~~
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM Y 7 ., .t .. TO v I~ 1^.
<br />174711 l17-231 /34751 /7G771 l18-791 136311
<br />Form Approved. ,
<br />~. T .; : t ~ „ .,. ,.OMBtNo.. 2040-000A ;. ~-
<br />(,- . I ~ n K ,,, T APDrovs4 e%giree OS-31-98
<br />*r
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<br />PARAMETER !3 Grd On1Y1 QUANTITY OR LOADING !I Grd Onlvl QUANTITY OR CONCENTRATION NO• FREOUENCr SAMPLE
<br /> 116531 154611 I3B-151 145-531 !5461
<br />EX OF
<br />TYPE
<br />137-371 MALrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sz-s31 154587 !6&701
<br />'J4CL'C'.""•/i .Y SAMPLE ..v#.# [:.;: f: 'j :J[-Y ,-. #r:#,~ ( 11.)
<br /> MEASUREMENT
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<br />"`I SAMPLE C-^.`~:4 r,:'k?4#4 #:::n##~` ( 12)
<br />- MEASUREMENT
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<br /> MEASUREMENT
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<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENILLTY OF
<br />MILIM WITH THE INFO LAW THAT I HAVE PERSONALLr EXAMINED MD
<br />RMATION SUBMITTED HEREIN; MD BASED OM TELEPHONE DATE
<br /> Mr INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR
<br />Richard Mlll OBTNNING THE INFORMATION, 1 BELIEVE THE sUBMITTFD INFORMATION IS
<br />T TH
<br />T ~
<br />s TRUE, ACCURATE MD COMPLETE. 1 AM AWME
<br />HA
<br />ERE ME
<br />SIGNIRCMT PENALTIES FOR SUBMITTIND FALSE INFORMATION
<br />INCLUDING
<br />Envfronmtantal N:~nager ,
<br />THE POSSIBILITY OF FNE MDIMPRISONMENT. sEE tB U.S.L.1100t MD93 SIGNATURE OF PRINCIPAL EXECUTIVE 970 870-2712 7 27 9B
<br /> U.S.C. 1 13t S. IM1nrtY. udr rMw IbNhF w.Y Icpd~ rrr.. w ro S IO,OW AREA
<br />TYPED OR PRINTED wW wnrrinun Anpiwmrrn of Mnrwn snwrrdMWSYwa! OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sl/ ettscnments Aerel
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<br />Epp Form 3320.1 (08.95) Previous `editions mey ba used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) n ~ n ~ T ~ n ~ r., ^ ~ _) n ~ „ PAGE 1 OF
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