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<br />NATIONAL POLLIRMT DISCMMGE ELIMINATION SYSTEM INPDE$)
<br />DISCHARGE MONITORING REPORT lOMR1
<br />12-161 I17-I91
<br />PERMIT NUMBER DISCMMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV i YEAR MO DAY
<br />FROM 'y Y L' I J 1 TO Y ~ U'~ ,:~
<br />120-21/ 112-231 !24251 126-271 /28-291 !3631/
<br />Form Approved.
<br />- „ , , _ ,- , .. ~ OMB No. 2040-0004
<br />( :) Approval e><piree OS-31-96 -
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<br />PARAMETER !3 Grd Onryl QUANTITY OR LOADING /4 Qrd On1y1 QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> (46-53) (54-6f) 13845) 74657 1566/ DF
<br />l31-371 EX MALY93 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e2-sai lµ661 168701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERn
<br />AM FM FV
<br />UNDm PENALTr or uw TNAr I NAVE PERSONALLr EXIMINEO MD
<br />/IDM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br />11,, MY INQNflY OF THOSE INDIVIDUALS IMMEDIATELY flESPONSIBLE F
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<br />OBTNNING THE INFORMATION
<br />I BEIJEVE THE SUBMITTED INFORMATION IS 1' ~' ~ ~
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<br />ACCUMTE MD COMRETE
<br />1 AM AWME THAT THERE ME ~
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<br />TYPED OR PRINTED rgrwr>inrn xlPnr..n.nr ae.I.r..nammn,.r,e6yw.I OFFlCER OR AUTHORED AGENT CODE NUMBER YEAR MO DAV
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<br />FPA Form 3320.1 106.95) Previous editions may be Geed. (REPLACES E'PA FORM T-40 WHICH MAY NOT BE USED.( = ! ~ , J)) . _) ~ Y ; PAGE I OF
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