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<br />SI31 S'fAT}: IIi~I1NAY 1.3
<br />NF;EK@; It CO H1641
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<br />LOCATION
<br />NATIONAL POLLUTANT 0' ROE ELIMINATION SYSTEM NPDESI Form Appr•
<br />DISCHARGE I fORINO REPORTPORT O~
<br />2-rsl rl-r9 SEC 16 POND TO T'OA'" ~F~ n~D~
<br />pproVe 1 Q 98
<br />(SI1DR NN) 12 45
<br />PERMIT NUMBER DISCHARGE NUMBEfl F - ' F I N A 1.
<br />MONITORING PERIOD M7NOR
<br />YEAR MO DAY YEAR MO DAY
<br />FRAM 91) 07 DL TD 98 06 30 y~°k# NO I~ISCIIAftG? 1--I ~ks~>`
<br />126111 l11-231 /24-251 E1E171 !2B-Y91 130-3r1 NOTE: Raa Inatructlone Eelor t1JM1lpletlnp thla farm.
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<br />132-371 EX A1aAlrvs TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l el~ea) I64-sal !6&701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EAAMINEO AND
<br />AM fAMILIAR N1TN THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON !
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<br />' TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR /
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<br />OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS J
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<br /> TflUE, ACCUMTE AND COMPLETE. I AM AWARE THAT TNFRE ARE S
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<br />' SIGNIFICANT PENALTIES FOq SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF NNE AND IMPRISONMENT
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<br />C bl ATURE OF PRINCIPAL EXECUTNE D
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<br />. 1 1 ]te. IP„WW, W« aw« .oMn. n,.Y iicAd. lvr, ry ro f 10,000 AREA
<br />TYPED OR PRINTED .n!«muFnYn a.wr/rav.,.nrwbrw..n 4monq,.n46Yw,.1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />wmm[n I o nnu IarLnnn I wn ur nn r vluLn I was Irroarenca mr srracnmanrs nere)
<br />ShTTLc'ADLC SOLIUS LIHI~.i ApP.LIES OVLY IF.<= lU-YR, 24-HR pRP.CIP EVENT IS CLA:LHF.D. iF CLAIM A^PROVF.D 9Y
<br />4QCb, TSG f. LBUN LI71iT5 'RILL NOT 9P. APPLIED TD REPORTED '1EASURFMENTS--SEE. T.. R.1 A, PC. 4 AND I.R,1D, PG 5.
<br />EPA Form 3320-1 106-951 Previous editions mey be used. IREPLACE6 EPA FORM T-40 WHICH MAY NOT eE U6ED.) „ _ _ , _ - _ _ _ _ _ _ - . PAGE GF
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