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<br />ADDRESSC!)LOaYO Y,INZ
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<br />FACILITY
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<br />A TT'N: J. [i. IiA?v0•i. I;=`•~"16L ^+A!CAGFk
<br />NATIONAL POLLUTANT DISCHARGE ELJMINATION
<br />DISCHARGE MONITORING REPORT
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<br />' ~ PERMIT NUMBER disc
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<br />.r... MONITORING PERIOC
<br />FROM
<br />I (NPDES) Form Approved.
<br />OMB No. 2040:0004
<br />'~ h I N 0 R Approval expires 0531-98
<br />T+ (SUBR Nil) '
<br />NUMBER F _ FiyAL flOTA2'
<br />`!INItiG pTT TO 5ECTI0~"i 16 POND
<br />DAV
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<br />PARAMETER (3 Cerd On/y) QUANTITY OR LOADIN
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<br />,' (g'bartl Only) QUANTITY OR CONCENTRATION .~
<br />. ` (38-45) (46-53f (51-67J
<br />• NO.
<br />vEX' FREOUENC
<br />OF SAMPLE
<br />TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~
<br />reau~1 ANALYSIS
<br />(89-68)
<br />69-70J
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSO NALLY E%AMINED AND / TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HER EIN. AND BASED ON MY /
<br />/
<br />' INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON SIBLE FOR OBTAINING ~~
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<br />THE INFORMATION, I BELIEVE THE SUBMITTED IN
<br />FORMATION IS TRUE. /'
<br />`,'',.`„'-,,r,.'
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<br />f ACCURATE AND COMPLETE. 1 AM AWARE THAT TH ERE ARE SIGNIFICANT ~ J
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<br />' J/,II n IJ ~I . r~ , r . , PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMEM SEE 1B U.S C. 41001 ANO 33 U.S.C.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE /j
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<br />TYPED OR PRINTED § t319 (Penal(ies untler these s2lures may inclutle lines up ro Ef0.000 antl or
<br />maximum ~mphsonment of behveen6montlu antl5 years.) OFFICER OR AUTHORIZED AGENT
<br />-~ R A
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<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />GOMMhN I S ANU tXPLANA I ION UH ANY VIOLA I IUN5 (H~leren0e all arYdOnmen[S ^ereJ `"
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<br />'11:1RITOiti)+G HEQUIP.ECSNTS S:: F. I.:t.1.F, pG. 5. N;RDF.'s OF PR^OF kEGUIHEMENTS - SEE I.A.3, PG. 4.
<br />EPA Fonn 3320-7 (08,95) Previous edltloris may.not be used. (REPLACES EPA FORM Tfi0 WHICH MAY NOT BE~USE~D.,), ~ yIy~ ~~~ ~ F
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