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PERMITTEE NAME/ADDRESS (Include Fanlrp•NamrlLocarian iJD$erenq
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMR; OMB NO. 2040.0004
<br />rz-ts! r77- sI ~' •"+^ Approval expires OS-31-98
<br />PERMIT NUMBER DISCHARGE NUMBER c - , , t , ,~ n _ ,
<br />MONITORING PERIOD -" •' T t, r, T p ..- ^ n n v n .J
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '1 7 !?', D 1 TO ~ ~. ~ : ~ ~ ... ... - ~.... 5 ..- ~ ~ ,.....
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<br /> (3 CaN Ony) QUANTITY OR LOADING (O Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46.53 (54-sf (3B<5 (46-531 (57-67 EX OF TYPE
<br />(32~R7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS 'Wa-~~
<br /> rtzml 64-6eJ 69-70
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<br />NAME7TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSO NALLY IXAMINED AND
<br />B
<br />AI TELEPHONE GATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND
<br />ASED ON
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<br />INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />
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<br />Richard Atills THE INFORMATION, I BELIEVE THE SUBMTRED INFORMATION IS TRUE,
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ^~ /
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<br />/ _ .'~~~,. ,/
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<br />EnvlronmentDl :1~.anager PENALTIES FOR SUBM1ITNG FALSE INFORMATION, INCLUDING THE 7O- 70-2712 7 8 99
<br /> ppSBIBIUTYOFFINEANDIMPRIBONMENT.SEEIBU.S.C.41051AN033U.S.C. SIGNATURE OF PRINCIPAL EXECIJTNE
<br />TYPED OR PRINTED 4 t319. (Pene7tiat under mesa s7etutes may include finer up m 570,000 arM a
<br />m~ximumlmpdsonmen7 of 5eMSenemen7h5 end5yoers.) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
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<br />EPA Form 3320.1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.) PAGE OF
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