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<br />LOCATION ,
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<br />NATIONAL POLLUTANT DISCHMGE EIJMINATON SYSTEM INPDESJ
<br />DISCHARGE MONITORING REPORT (DMR1
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM Y/ 1 L L' I TO Y( _ I
<br />110.17) 122-Z3) 12415) 71b171 f18-29/ !36311
<br />Form Approved.
<br />f'r ... T'i ~.: L ~r 4 _ OM8 No. 20A0-0004
<br />( ~ ~ Approve! expires 06-31-98
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<br />NOTE: Reed Inetructioru before completlnp this iwm.
<br />PARAMETER I3 Grd Ontyl QUANTITY OR LOADING f4 Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> ft4531 /50.611 /3BJ5 146-531 154611 EX DF
<br />131-971
<br />M/AiYSs TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e7-as/ 160-fiBl 15370)
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I cERn
<br />FU.1 FA Fr vNDw PENUTr of
<br />MIDAR WITH THE INFO uw THAT I NAVE PEASONAttr ExAMwED AND
<br />RMATION SUBMITTED HEADN; MID BASED ON TELEPHONE DATE
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<br />K f~ ~~J Mr INQUIRY OF THOSE INDINOUALS IMMEDIATELr RESPONSIBLE FOR
<br />OBTNNING 7HE INFORMATON, I BELEVE THE SUBMITTED INFORMATION 19 ~ ...!
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<br />TRUE, ACCURATE AND COMRETE. I AM AWARE THAT THERE ME
<br />AGNIRCANT PENALnE9 FOR SUBMITTNG FALSE INFORMATION
<br />INClWINO ~
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<br />THE PoSSIBIUTY OF RNE AND IMRIISONMENT
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<br />. SIGNATURE OF PRINGPAL EXECUTNE
<br /> V.S.C.11B1e. rFrlNnfu lMYfMM mWM1a.eFY rxAiar hN.W roFIO,D00 AREA
<br />TYPED OR PRINTED MarnMrirt.n 1rp10'Fn.+rNbnxwn anu+M.W aYxs.+l OFFICER OR AUTHORIZED AGENT CODE NUMEN:R YEAR MO DAV
<br />GOMMtN I5 ANU tAr'LANA I I V N Uh ANT V I V LA I IONS (MB/6lenCB e// eReCOTBOlS OBrel
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<br />EPA Fwm 3320-1 (08-961 Previous editions mey be used. (REPLACES EPA FORM T<O WMICN MAY NOT BE USED.) ~ 1 ; 'I ~~ - i i .. PAGE : OF
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