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PERMITTEE NAME/ADDRESS Ra~iisMryNar/Lxmlan UDipnm)
<br />NAME :_ -, .
<br />ADDRESS 'I:
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<br />FACILITY
<br />LOCATON . ?. ~. _ ,
<br />NATIONAL POLLUTMT DISCHMOE EUMINATIOM SYSTEM lNPOES) Form Approve0.
<br />DISCHARGE MONITORING REPORT IDMRI ~ _I .! : - r., ; _ I ~ I~or 2040-00040
<br />7-1a~ n-r91 I , i C RGMBI .
<br />' '; j !' .'; 1 / 0 ~ , i ~ „ .. .: J APProval' exPiree 05-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER _ ~ a ,
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM - - - TO » 1 - I __
<br />Iza7l, lz7-731 !zI-z5, rz6-771 11a-791 13P3,1 NOTE: Rnd Inetructlane belon completing thu form.
<br />PARAMETER l3 CArd Ontyl QUANTITY OR LOADING 14 Grd OnNI QUANTITY OR CONCENTRATION ND FREDUENCY SAMPLE
<br /> 106531 !5461 I3BJ51 !46531 !54611 EX O
<br />Y TYPE
<br />/37-37/ MA
<br />515
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<br />NAMERFFLE PRINCIPAL EXECUTNE OFFICER I OERTI
<br />AM FA FY UNDER PENALTY OF UW THAT I HAVE PERSONALLY EXAMINED MD
<br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON ~ ~ TELEPHONE DATE
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<br />MY INDUIRY OF THOSE INDIVIDUALS IMMEDIATELY R
<br />OBTNNIMO THE INF011MATION, 1 BELIEVE THE SUBMITTED INFORMATION IS ~ ,
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<br />OFFlCER OR AUTMORIIED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lNararence en smcnmenrs oars!
<br />Epp Form 3320.1 108-95) Previous editions mey be used. (REPLACER EPA FORM T-0O WHICH MAY NOT 8E USED.1 ~ - PAGE . OF
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