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<br />NATIONAL POLLUTANT DISCHMGE ELIMINATON SYSTEM /NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT lOMRI _ . _ _ .. - OMB;No: 2040-0004
<br />11-161 17-191
<br />Approval expires OS-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER ~ _ ~ •~
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM ,, .. ~ I TO - .. ...... - .. 1
<br />!26111 l11-131 l14-151 176-171 118-191 !34311 NOTE: Reed Instrucliaru bola com Istinll this lorm.
<br />PARAMETER !3 Cerd Ontyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 106-531 !54611 138-451 !46531 !SC-61 DF
<br />l3I-371 EX
<br />MALVSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsr-s.Tl ls4-5B1 !5&70l
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERT FY UNDER PENMTV OF UW THAT I NAVE PERSONALLY E1(AMINED AND TELEPHONE DATE
<br /> AM FA MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON
<br />(:.ICY1:-IPL; ~/I I!S MV INQUIRY OF THOSE INDINDUMS IMMEDIATELY RESPONSIBLE FOR
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<br />F!7V ~T'L-lffl2liiLt~ I'l7i ll:*f~CI'
<br />- OBTNNINO THE INFORMATION, I BEU EVE THE SUBMITTED INFORMATION IS
<br />TRUE. ACCUMTE AND COMRETE. I AM AWIWE THAT THERE ARE
<br />SIGNIFICMT PENKTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 MID 93 gIONATURE OF PRINCIPAL EXECUTNE
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<br />EPA form 3320.1 (08.961 Previous editlone may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE U6ED.) ., ,, ~ ., ~ „ ~ ~ , ~ 7 - - PAGE ., OF
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