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PERMITTEE NAME/ADDRESS (bdi6r FsWryN../lsnron pD,p....q
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<br />LOCATION
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATON SYSTEM (NPDES) Fonn Approved.
<br />DISCHARGE MONITORING REPORT (OMRI ~ -. ~ -.OMB-.No: 2040-0004
<br />!T-151 17-191 -
<br />-~ - -. ~ ~ ~ Approve! a:pirea OS-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER _ ,
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO -. _. - -' -. , . I
<br />1767 I1 !TT-T 31 !14151 !76771 /T@-791 !36311 NOTE: Read InatructlolN before co plating thla form.
<br />PARAMETER l3 Ord Onlyl QUANTITY OR LOADING 14 Ord OnNl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !16531 1546/1 l38-451 !4653 !546/1 GF TY
<br />l3T-371 EX
<br />µAivsls PE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161-s]! !5/.581 l5A701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENN.TY OF UW THAT I HAVE PERSONALLY E%AMINED AND
<br />MILIN\ WITH THE INFORMATION SVBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR
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<br />:.' .I :a1YL. ~ `I I I i
<br />' OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ,
<br /> TRUE. ACCUMTE AND COMPLETE. I AM AWARE THAT THERE IJ1E
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<br />' SIGNINCNIT PDIALTIES FOR SUBMITTING FN
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 1B U.S.C. E 1001 Ni0 ]]
<br />BIONATURE OF PRINCIPAL E7EECUTNE ~
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<br /> U.S.C. ! 1]1a. IMWIMAUW M~ mWh. mY McANP lwaW ro tlO,000 AREA
<br />TYPED OR PRINTED .esnmuinun inpda+rMTt of MlwwnsmonrN rdbYra/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMEN I~ AND EXPLANA ETON UY ANY VIVLA IIVN, fHe7efenCe l//eRBCAmsnis helBJ
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<br />EPA Form 3320-1 108-961 Previous editions mey be used. IREPLACFS EPA FORM 740 WHICH MAY NOT BE UbED.I ., _. ~., , _ ~ r PAGE OF
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