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<br />FACILITY
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<br />NATIONAL POLLUTANT OISCNMOE EiIMINATION SYSTEM (NPOESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />l7-I61 l17-I91
<br />PERMIT NUMBER DISCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM 'I'S .° TO ''" :'
<br />!16111 l11-131 /14151 !16171 118-291 !303/1
<br />Form Approved.
<br />w T r. •• ~ F ~ U.[ r - -lOfKIB.Noa 2040-0009-:..
<br />~ N Approve expires 05=31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF L
<br />MILIM WITH THE INFO AW THAT I HAVE PERSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN
<br />MD BASED ON TELEPHONE ,DATE
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<br />MY INO
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<br />Richard h9111s UIIIY
<br />HOSE IN
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<br />MMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br /> TRUE. ACCUMTE MD COMRETE. I AM AWME THAT THERE ME
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<br />E SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />EPA Form 3320-1 106-95) Prevloue eddlone mey ba used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 r` r ~ = T / ~ ~,~ ~ ~ - t ,~ 1 ~ PAGE ~ OF
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