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pERMITTEE NAME/ADDRESS(lwetrdr FrrlrryNa./I,ecura /D~...nrl
<br />NAME '
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<br />NATIONAL POLLUTMT DISCNMOE ELIMINATON SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMRI ~ ~ , I ,, / T •~ 1 ~~' C a 9M~".°' 2040.f~4F
<br />11-161 17-191
<br />:~ ' S 0 G i J J,J y ;, I ,, ~; ., : .) Approval, elCgir_PP 0 -31-98
<br />PERMIT NUMBER DISCHMGE NUMBER _ ~ I
<br />MONITORING PERIOD ~
<br />YEAR MO DAY YEAR MO DAV
<br />FROM - ~ ~ ~ TO - - - ~ ~ ~ I
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<br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !4 Grd Onhl QUANTITY OR CONCENTRATION NO FREOUENCV SAMPLE
<br /> lIE531 !54611 I3B-451 !46631 154611
<br />EX of
<br />TYPE
<br />l32-371 ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !ea-edl 164-6B1 !63701
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I NAVE PERSONALIV EXAMINED MD
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN; MO BASED OM ~ TELEPHONE DATE
<br /> MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIDLE FOR // ~/
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<br />,1Clid,c (] N, /'IL1TL: C1. OBTNNING THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br /> TRUE. ACCUMTE MD COMPLETE. I AM AWM
<br />AT THER
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<br />INCLUDING
<br />BIGNIFICMT PENKTIES FOR SVBMITTING FALSE INFORMATION ~
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<br />. iCe Pre=ldPnt , / .
<br /> THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE to U.S.C. E 1001 AND ]] / .OIONATURE OF PRINCIPAL EXECUTNE
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<br />TYPED OR PRINTED
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<br />OFFICER OR AUTHORIZED AOENT
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRslerence s// ettschmenfs here!
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<br />Ef.; Form 3320-1 108-%1 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) - . / / ~ _ PAGE , OF
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