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<br />PERMITTEE NAME/ADDRESS (lri,dr FxWry Nn,Wlecanan 1lDr)lnrn)
<br />NAME JJ~jG !iL~i J,l4: ",i, Lla1I':. l)
<br />ADDRESS H J .I L G R) . Z ' I ~! E:
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<br />FACILITY -1'J.li., I'F,J)'rR_GJF LI•:IC~'•L
<br />LOCATON
<br />NATIONAL POILUTANi DISCNAROF ELIMINATION SYSTEM INPOES)
<br />DISCHARGE MONITORING REPORT lOMRI
<br />11-161 117-191
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<br />^ PERMIT NUMBER DIBCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM / ;S '%1 J L TO 'i ~ i
<br />/16171 /17-?31 /1d-15/ 17617/ /18-191 /36311
<br />?'JNA C U5:6~; ;
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<br />NOTE: •e netruceone ~bs or eompletina Lhb form.
<br />PARAMETER !3 Grd Only! QUANTITY OR LOADING !I Ord On1Y1 QUANTITY OR CONCENTRATION NO, FREQUENCY SAMPLE
<br /> !4653/ 15d-511 13BJ51 1db53 lSb5E1
<br />EX OF
<br />131-J)1 ANALVas TYPE
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS !62.691 !54581 153701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDFR PENALTY OF LAW THAT I NAVE PERSONALLY E%AMINED AND -- TELEPHONE DATE
<br /> AM FAMILIAR WITN THE INFO RMATION SUBMITTED HEREIN; /JIG BASED ON - / ~ )
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<br />~ FI ~N ~ I IO L R MY INOUIRV OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~~
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<br /> TRUE. ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ME
<br />SIONINCMIi PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />OFFICER OR AUEHORI2ED AGENT
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<br />COMMENTS AND EAPLANATIVN Ur qNY VIVIq 1lons IHBTBrenCe an srtecnmenT9 nsrel
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