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<br />FACILITY
<br />LOCATION
<br />ITT I'_r1A~:J L. rT.99. 1'S. yr of CONS
<br />NATIONK POILUTMT DISCHMGE EUMINATOM SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />1-161 /17-I91
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO pAY YEAR MO DAV
<br />FROM ti 's C 4 t, TO ~' o ~ I_
<br />/1611/ !11.131 /I415/ 116271 /IB-191 !36311
<br />Form APProvad.
<br />P ~~ :. i '! „ li L'. -: ~. , OMB No. 2040-0004
<br />~ ; I J • ;, ~ y,) Approval expilee 05.31-98
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<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENKIY OF LAW THAT I HAVE PEflSONKLY El(AMINED MD
<br />AM FAMIUM WITH THE INFORMATION SUBMITTED N01DN
<br />MD BARED ON TELEPHONE DATE
<br /> ;
<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~ _
<br />
<br />OBTAINING THE INFORMATON, 1 BELIEVE THE SUBMITTED INFORMATION IS /
<br />~~
<br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT TNERE ME
<br />SIGNIRCMT PENKTES FOfl SUBMITTNO FKSE INFOMIATION
<br />INCLUDING
<br />~7
<br />~Z ~~ ~ /y
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<br />THE POSSIBILITY OF qNE MD IMPRISONMENT. SEE 10 U.S.C. 1 1001 MD 37
<br />SIGNATURE OF PRINCIPAL EXE('17TNE ~) 7~.- 7
<br /> U.S.C. 7 1710. /ErM#A unM ewe prune *wY arA.w fiver ~ n t/0,000 AREA
<br />TYPED OR PRINTED w a mv:r..n rrpd>mnra W bw..n a III>IerA nrd B r..:) OFFlCER OR AUiHOR¢EO AGENT CODE NUMBER YEAR MO DAY
<br />a,ummcn r a nnv cnrutrvn r n,n rrr nn, vw~n I rvrw rrterersnce an euecnmenrs natal
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<br />EPA Farm 3320-1 (08.95) Previous editions may be used. IRE-LACES EPA FORM T40 WHICN MAV NOT BE USED.1 ~ ~ / j 1 t i _ ~ ~I t PAGE OF
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