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<br />9100 P.~i: ,. 'I _~ ..~ .
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINA^ON SYSTEM INPDESI FOTm ApprOVBd.
<br />DISCHARGE MONITORING REPORT IDMRI ..^v„f '„+, f11M&No~2040-0004.
<br />l1-ISl I7-191 ~ ~ . rt T l
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<br />PERMIT NUMBER DISCHMGE NUMBER -• t T F A 1
<br />MONITORING PERIOD ° E I^"
<br />YEAR MO DAV YEAR MO DAY
<br />FROM './ TO '~rv ..... 'I'I •'t'r r+~ I I ,~,; 1,:
<br />!16211 111-131 !14151 !16171 119-191 !36311 NOTE: Rasd Instructions belore completing this form.
<br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING l4 Grd OnIYI QUANTITY OR CONCENTRATION NO FREOUFNCY SAMPLE
<br /> /46531 154-611 138-451 !4653 !54511 EX GF T
<br />PE
<br />131-371 gNALY515 Y
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sZ-s~1 154581 169-701
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDFA PENN.TY OF LAW THAT I HAVE PERSONN.LY EXAMINED AND
<br />MIUM WITH THE INFORMATON SUBMITTED HEREIN: AND BASED ON ~ TELEPHONE DATE
<br />
<br />Richard M1~lf ll:i MY INQUIRY OF TNOSE INDIVIDUN,9 IMMEDIATELY RESPONSIBLE FOR
<br />I BELIEVE THE SUBMITTED INFORMATION 19
<br />OBTNNING THE INFORMATION
<br />
<br />Env{ronmenta! I'1~:~~8ger ,
<br />TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE
<br />SIGNIFICANT PENN
<br />TIES FOfl SUBMITTING FN
<br />SE INFORMATON
<br />INCLUDING .~
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<br />970) R70-27I ~
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<br />THE POSA8ILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. f 1001 AND J7 SIGNATURE OF PRINCPAL EXECUTNE
<br /> U.9.C. E t Jt e. l/i,rltlrF t.llr rMw F,YNIFF nvY M,cA.W rMMF W ro F IO,000 AREA
<br />TYPED OR PRINTED AMrmulmun Mplwmwtr a/MrwwnemonU.AMerral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/erencs e!I etteehments here/
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<br />EPA Form 3320-1 108.95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE UBED.) ,t n ^ T ~ / „ ., r II ~ ./ _ 1 ^ t , PAGE t OF
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