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<br />NATIONK POLLUTANT DISCHMOE ELIMINATION SYSTEM /lvPOE$1
<br />DISCHARGE MONITORING REPORT lOMR1
<br />l2-161 /17-I91
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONRORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM uy IU U TO ~Y ~1
<br />/26211 l22-I31 /14251 /?4271 /28.191 /3(1311
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<br />Form Approved.
<br />OMB No. 2040-0004
<br />Approval expires OS-37.99
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<br />ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS fe2del 1µ68l 163701
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<br />N ME/TITLE PRINCIPAL EXE~IITNE OFFICER I QERn
<br />'AM fA Fr
<br />uNDER vENALTr of uw THAT 1 NAVE PERSONALLr E%AMINED AND
<br />MIDAR 'IATII THE INFORMATON SVBMITTED HERDN; AND BASED ON TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDVALS IMMEDIATELY RESPONSIBLE FOR ~
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<br />/ OBTNNING THE INFORMATION
<br />1 BELIEVE THE SUBMITTED INFORMATION IS ~1 ~'
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<br />IAUE. ACCURATE AMO COM0.ETE I AM AWARE THAT THERE ARE
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<br />THE POSSIEIDTY OF RNE AND IMPRISONMENT
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<br />eIOMATURE OF PRINgPAL EXECUTNE /
<br /> U.S.C. f 1310. f/N+WahA uMr eww AbrobF wY >rrrAAF ln.a W ro F IO,QOD AREA
<br />TYPED OR PRINTED rwrmuNVn~,wlvsnteaaMar~ams,wdeY.w'tl OFFICER OR AUTHORRED AOENi CODE NUMBER YEAR MO DAY
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<br />EPA Form 3320-1 IDB-951 Previous editions mey be used. ?REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ., ~ / • ~ I 1 _ I I PAGE . OF
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