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PERMITTEE NAME/AODRE55 (1~LfsWry Nar~laaNen l/D~G.nO
<br />NAME ]ENliC:'. .','' 1i. C'.,"~ F.:, Y
<br />ADDRESS D !1 A A •- ~ L' '
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<br />~d,. FACILITY
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<br />di.n. ~.. uUi! nY:iw>(~ Gt`.EIILL hANP.G!:k
<br />NATIONAL POLLUTANT DISCNMGE ELIMINATIDN SYSTEM l/VPDE$f
<br />DISCHARGE MONITORING REPORT (OMR)
<br />(?-161 /17-19/
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<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i u ui TO = 1
<br />._va n6]A nR-]91 /30.311
<br />Form APPraved.
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<br />PARAMETER !3 GId Onlyl QUANTITY OR L- G /I Grd On/Yl QUANTITY OR CON TION ND, FREQUENCY SAMPLE
<br /> /a5-53/ (54611' '- !38<51 (d6-53 154-6f) EX µ~vys TYPE
<br />(32-371 AVERAGE MAXIMUM NITS
<br />• MINIMUM AVERAGE MAXIMUM UNITS /s]-ssl (6•t681 (69-7DI
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<br />NAMEfTRIE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENUTY OF LAW THAT I HAVE PERSONALLY EkAMINED AND TELEPHONE
<br />\ DATE
<br />~
<br />AM FAMILIAA WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON
<br />MY INQUIRY Of THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR ` )
<br />OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATON IS ',
<br />TRUf, ACCURATE AMD COMPLETE. I AM AWARE THAT THERE ME ~ y~~
<br />SIGNIFICANT PENALTIES FOR SUBMITTIND FALSE INFORMATION, INCLUDING
<br />THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 1B U.B.C. E 1001 AND 37
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<br />COMMENTS AND EXPLANATION OF ANY VIOLA (IONS lRe/ersnce sn snscnmenrs oars/
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<br />EPA Fwm 3320.7 108.951 Previous editions may be used. l (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) C : C 3 ° / 9 7 I C 1 I- 1 r 1 3 PAGE I OF
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