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<br />NATIONAL POLLUTANT DISCNMOE ELIMINATION SYSTEM /NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT IDMR1 -, ,T ., - OIdB•No~ 2040 ,4 ~,/
<br />17-15 17.191 - ,°, C '. l .~ .. .~~
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<br />PERMIT NUMBER DISCMMGE NVMBER ~ _ -
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<br />YEAR MO DAY YEAR MO DAY _
<br />FROM TO .,. ~ __,
<br />!16711 l77-731 !14.751 /1677/ 118-791 /3631/ NOTE: Reed Inetructiarr belore completing this form.
<br />PARAMETER - !3 Grd Onry/ QUANTITY OR LOADING /4 GId Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146531 l5b511 138151 !96531 l5L511 DF
<br />l37-371 EX
<br />µALYS15 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS res-esl 18a-5Bl 159-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFlCER 1 CERTIFY UNDER PENALTY OF LAW TNAT I HAVE PERSONALLY EJfAM,NED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; µD BASED ON -
<br />/ TELEPHONE DATE
<br />
<br />:Iichard ',:. i'IL1L :9071 MY INQUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />SCR Yreradent TRUE, ACCUMTE µD COMRETE. I AM AWARE THAT THERE µE
<br />SIGNINCANi PENALTIES fOR SUBMITTING FALSE INFORMATION
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<br />THE POSSIBILITY OF NNE µD IMPRISONMENT. BEE 1B U.S.C. f 1001 µD ]]
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<br />' ! SIGNATURE OF PR ICIPAL EXECUTNE / . r l
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<br />TYPED OR PRINTED rMwmulmnr imp/minrrr ale+er+m em+nNa+MeYAVa/ OFFICER ORA ORIZED AGENT CODE NUMBER YEAR MO DAY
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<br />Ep(L Form 3320-1 108-95) Prevloue edrtlonB mey bs used. (REPLACES EPA FORM 740 WHICH MAV NOT BE USEO.1 I / ~ PgGE : OF
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