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<br />NATIONAL POLLUTMT OISCHMOE ELMINATION SYSTEM (NPOESI FDrm ApprOVed.
<br />DISCHARGE MONITORING REPORT (OMRI - OMB No. 2040-0004
<br />lI-161 !17-191 - '- '
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<br />PERMIT NUMBER DISCHMGE NUMSER ~ - I . - ;
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<br />YEAR MO DAY YEAR MO DAV --
<br />FROM t; ~•. t 70 1, ., _ . ~ .. - ~ .. . 111, ~ _ i _ _ ~ .. .
<br />!76711 112-131 114151 IS6-771 11a-791 1363(1 NOTE: Rasd Inetructloru baton completing this form.
<br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !4 Grd Ontyl OUANTITV OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146-531 l5b61 138-051 146-531 /51-511 of
<br />137-371 EX MALY519 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS Ie7.sal 160-681 169-701
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<br />NAMERITLE PRINCIPAL E%ECUTNE OFFICER I cERn
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<br />MIDM WITH THE INFO Aw THAT I NAVE PERSONALLr ExAMINED MD
<br />RMATION SUBMITTED HEREIN; AND 9ASED ON
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<br />/~CJ:JI/ ~1 MY INQUIRY Of TN09E IMDINDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />SIGNIFICANT PENALTIES FOR SUSMITTINO FALSE INFORMAnON
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<br />,),( THE POSSIeIVTY OF RNE MD IMPPoSONMRIT. SEE 79 U.S.C. E 1001 AND ]a
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<br />EPA Form 3320.1 (08.861 Pnviom edibone mey be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 ~ J ;~ } j i .. -. I .I ~ „ PAGE 1 OF
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