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<br />ADDRESS TkA PYFR •TV2
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<br />FACILITY
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<br />NATIGNDISCLHARGE MONRORINO REPORT (OM NPDES/
<br />2-181 17-191
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YE D Y YE R MO DAY
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<br />/76211 l22-231 12~-351 116-171 178-291 134311
<br />Form Approved, -
<br />r1 I tl :7 ° OMB No. 2040.OOOA ~, -
<br />(3 0 ~ R •~ q) Approval expires 06-~31-98'
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFflCER I CERT
<br />AM FA FY UNDER PENALTY OF L
<br />MILIM WITH THE INFOR AW THAT 1 HAVE PERSO
<br />MATION SUBMITTED H NALLY E%M11N[D AND
<br />EREIN
<br />AND BASED ON TELEPHONE DATE
<br /> MV INQUIRY OF TNOBE INp+NDUALS IMMEDIATEL ;
<br />Y RESPONSIBLE FOR /w _
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<br />W, r.,ordOn PeterB OBTNNING THE INFORMATION, I BELIEVE THE SUBMI
<br />TRUE. ACCUMTE AND COMPLETE- I AM AWAR TTED INFORMATION IS
<br />E THAT THERE ME ~ `. ~~,.~-'~'
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<br />g70-8_4-440 99 10 Z]
<br />T SIGNIFCANT PENALTIES FOR SUBMITTING FALSE INFO RMATON
<br />INCLUDING
<br />resident General Manager ,
<br />THE POSSIBILITY OF NNE AND IMPRISONMENT
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<br />EPA Form 3320-T (03.961 Prsvioua editions may be used. /REPLACES EPA FORM T30 WNICR MAY NOT BE USED.) 7 0 ~ ~ ~ / r, q n ry ~ I_ I ~j ~ o PACE T OF
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