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PERMITTEE NAME/ADDRESS (TnrW. Fre,ryN.ndLra,an dDlQannp MATIONK POLLUTANT DISCHARGE ELMINATOM SYBTEM (NPOESI
<br />NAME „ r !; ~: 1 : 1 : ~ ~: r, d 4' :. L C (1': , T . I, !; . DISCH? R6 E MONITORING REPORT!(OM9/
<br />ADDRESS, .i'r: T - ~: 5.1i1%? Ti:l
<br />L~ ~ . I 7 ; PERMIT NUMBER DISCHARGE NUMBER
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<br />YEAR MO DAY YEAR MO DAV
<br />LOCATION FROM ': ,~ I U L' 1 TO V tl
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<br />Form Approved.
<br />.• i,-, .. •, ; -_!.'%.. - , OMB No. 2040-0004
<br />t . I I ~ 1~) ApprovM expires 05-31-98
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<br />NOTE: Reed Inetruetloru before eompletinp thle lorm.
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<br /> (4E531 (5a6T1 /38-65 (46-53) 15b6/ EX OF
<br />132-371
<br />ANKY515 TVPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.6]1 161-681 /6¢701
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<br />NAME/TITI.E PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDE11 PENKTT OF lAW THAT I HAVE PERSONKLY E%AMINED AND
<br />AM FAMll1AR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON _. TELEPHONE DATE
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<br />MY INQNRY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING 7ME INF011MATON, 1 BELIEVE THE SUBMITTED INFORMATION IS
<br />TRUE, ACCUTATE AND COMRETE. I AM AWME THAT THERE AIiE
<br />SIOMIRCANT PEHKTIE9 FOq SUBMITTIMO FKSE INFOMIATIOM
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<br />GOMMCNIS ANV a/LYLANA IIDN W ANT VIULA IIVNS !/reference ae srternmsn6 Here/
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<br />EPA Farm 3320-1 (08-95) Previous editions mey be used. IREDLACEB EPA FORM T40 WHICH MAY NOT BE USED.I ~, / ~ 1 ~ _ ~ ~ PAGE ~ OF
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