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<br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES)
<br />DISCHARGE MONITORING REPORT (OMRI
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
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<br />(zo-z11 Rs-zs) R4-zsl Re-sT) (1848) (3aaf)
<br />Forth Approved.
<br />~ ~ . OMB No. 2040-0004
<br />Approval expires 0531-98
<br />~ NOTE: Read Instructions before completing this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53 (54-61) 381s 46-53) 54-8f EX OF TYPE
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<br />NAME/TITLE PRINCIPAL IXECIlTIVE OFFICER I CERTI
<br />AM FAM FY UNDER PENALTY OF
<br />ILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br />A
<br />
<br />Richard h,llls
<br />INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
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<br />SIBLE FOR OBTAINING
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<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR BUBMITTIN
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<br />Epp Form 33261 (OR-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WNICH MAY NOT BE USED.) ~ n T 1 ~ / Y T r} (I 1 '-1 ` ~ rL PAGE 1 OF
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