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PERMITTEE NAME/ADDRESS lIrsrL FrWryNrWLocnlan JD,p..wp
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<br />LOCATION
<br />NATIONAL POLLUTANT DIBCNAROE ELIMINATION SYSTEM lNPDESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />12-I61 lI7-191
<br />~J0~271~7 ^t17 ?
<br />PERMIT NUMBER DISCNARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM ~ I _ TO c~'~' ^ cl I ~'
<br />!16211 l27-731 134151 176-771 l18-191 l3Q3//
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<br />Form Approved.
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<br />Approve4 expires 05-31-98
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<br />`NOTE: Reed instructions balq com tiny this lorm.
<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING !4 Grd Onhl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br />3 146-531 150-611 138-451 1e653 15C-671 OF
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<br />2-371 EX
<br />ANALrss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167~6J1 !64681 !69701
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<br />"LJEVT ~9~;° Y%L~I^ REQUIREMENT .:':- T.;-R .,AL, ., .:/T, ^,Vllr
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENKTY OF LAW THAT 1 HAVE PERSONALLY E%AMINED AND
<br />MILIAR WITH THE INFORMATION SUBMITTED NEREIN; AND BASED ON TELEPHONE DATE
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<br />d Mffls MY INQUIRY OF TNOSE INOIVIOUALS IMMEDIATELY RESPON9BLE FOR
<br />OBTNNING THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS _
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<br />AWARE THAT TNERE ARE
<br />SIGNIFCANT PENALTIES FOR SUBMITTING FUSE INFORMATION
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<br />(970) g7D-2712
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<br />EPA Form 3320-1 108.85) Previous edmons mey bs used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.! r ~ ., ^ ~ / .~ ,, !, ~ T T ^ ~ ~ PAGE OF
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