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PE ~ E/ADDRESS pndude Faciliq•NamelLacarian ifDi$erern)
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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (F1PDE5}
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2-16) (1l- 9)
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<br />P MIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 99 04 9 TO nn nF. 7n
<br />rM211 msal th'~ nx-~n rze-?91 r]g3n
<br />Form Approved.
<br />OMB No. 2040-0004
<br />"' ° „ Approval expires 051-98
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<br />PARAMETER Onry) pUANTITY OR LOADING Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br /> 46-53 (34~B1) (38-43) (46-53) 34-61) EX OF TYPE
<br />(32-37)
<br />AVERAGE
<br />MAXIMUM
<br />UNRS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />
<br />roz~d1
<br />ANaLYB(S
<br />(84-68)
<br />
<br />6&70
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL E7(ECUTNE OFFICER I CERTIFY UNDER PENALTY OF L
<br />AM FAMILIAR WITH THE INFORM AW TV{AT I HAVE PERSONALLY E7UMINEO AND
<br />ATION SUBMITTED HEREIN
<br />ANO BASED ON MY TELEPHONE DATE
<br />
<br />Richard hitlfs INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
<br />I BELIEVE ,
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE SUBMITTED INFORMATION IS TRUE
<br />1
<br />
<br />Environmental A4ana
<br />er ,
<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMfRING ,
<br />I AM AWARE THAT THERE ARE SIGNIFICANT
<br />FA
<br />E INFORMATION
<br />INCLUDING T ~ ~r / A
<br />r ~ '
<br />~
<br />9]Q
<br />8]Q-2]12
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<br />28
<br />99
<br />g POSSIBILITY OF FINE AND IMPRI LS
<br />,
<br />HE
<br />SONMENT. SEE to U S.C. 41001 AND 33 U.S.C. _
<br />SRiNATURE OF PRINCIPAL IXECUTIVE -
<br />
<br />TYPED OR PRINTED 5 1318. (PeneNet wtler Nsse s
<br />mfldmum impnsonmenl of benveen mnrtes may inclWe fides up w frg000 arM a
<br />BmunNS entl Syeers.J OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />GUMMtN I S ANU tAYLANATION OF ANY VIULATIUNS (RBJerenCe aJJ efteChmenLS hale)
<br />~~?PLEA,iLc ::^LT' ~ LT°I" TV~'n u l vu~~• v pnr r~ r. frr'r_c v +~ ~ nr TIC C 1lncrc•r,•C nt+, r.
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<br />EPA orm 332o-1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br />nDl~~~nnn4i?-151 ~
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