PERMITTEE NAME/ADDRE55pMrf. Fku~y.Va/ls.uw l/D~.r..rl
<br />NAME ~ I .
<br />ADDRESS - i P ~ ~ ~ - ~ --~ . ~ ~ -
<br />FACILITY
<br />LOCATION
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<br />NATIDNAI POLLUTANT DISCHARDE ELIMINATON SYSTEM (/yPOESI FOEm ApprOVed.
<br />DISCHARGE MONFFORING REPORT (OMRI v , .. ,. _ - . -.OMB No: 2040-000,40+•
<br />11-161 117-191 '
<br />-. _ „ ~ ., , . ~, ! _ .. Approval expires 05-31 ~98
<br />PERMIT NUMBER OISCHMGE NUMBER -
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ,~ ~ TO ,. .....-. ~ I •i:
<br />l1P7/I !II-I31 !74251 !16171 178-191 !3631/ NOTE: Raed InetruetiaM bslo co Slop this }orm. ~.
<br />PARAMETER l3 Gte On/yl QUANTITY OR LOADING /I Grd OnlYl QUANTITY OR CONCENTRATION NO, mEQUENCr SAMPLE
<br /> 146531 (54611 l38a51 !16.53 154-511
<br />EX of
<br />I31-371 ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sa-ss~ I6q-661 I69-701
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<br />NAME/TITLE PRINCIPAL EXECVTNE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR NrITH THE INFORMATION SUBMITTED HEREIN; AND eASED ON
<br />L,'Vr~_~ fl ~.~'~~ MY INQUIRY OF THOSE IMDIVIDUKS IMMEDIATELY RESPONSIBLE FOR
<br />i OBTNNING THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />Fi1~/IPOiI P,r,: rt T~ ;i7 •l3 nl:I'•
<br />') TRUE, ACCUMTE AND COMPLETE. I AM AWARE THAT THERE I1RE
<br />SIONIFCANT PENALTIES FOR SUBMITTIND FALSE INFORMATION
<br />INCLUDING .
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<br />THE POSSIBILITY OF NNE AND IMPN
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<br />COMMENTS AND EXPLANATION OF ANr vIOLAT1oNS /Reference sn attecnments oars!
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<br />EPA Form 3320-1 108.961 Previous editions may be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.1 ,, r .. / - ,, ,. _ PAGE . OF
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