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PERMITTEE NAME/ADDRESS ll.a~b FrdrryNad(aw,a l/DIp ul
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTMT DISCNMOE ELIMINATON SYSTEM /NPDESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />17-I61 I7-191
<br />PERMIT NUMBER DI9CHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM ~ TO - 1 ~ '
<br />/]0.]!l /]]491 UL151 /]6-]71 /]e-]91 /30.311
<br />Form ADProved.
<br />- - - - OM&No. 2040-0004
<br />I . ., t Approval a:pirss 06-31-98
<br />. -~- 1 I -
<br />NOTE: Read Instructions betas completlnq this Corm.
<br />PARAMETER 13 Grd OnNI QUANTITY OR LOADING !I Grd OnlYl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> l46-531 !566/1 /38-051 !46-53 !54671
<br />EX OF
<br />TYPE
<br />131-371 Murgs
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163-6]! !646191 !63701
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<br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM iAMIL1M WITH THE INFO UW TNAT I NAVE PERSONALLY E%AMIXED MD
<br />RMATION SUBMITTED NEREIN; MD BASED OM TELEPHONE DATE
<br /> MY INQUIRY OF TM09E INDINDUAL9 IMMEDIATELY RESPON9BLE FOR
<br />,~~ OBTNNING THE INf011MATON, I BELIEVE THE SUBMITTED INFORMATION 19
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<br />1 TRUE. ACCUMTE MD COMPLETE. 1 AM AWME THAT TNERE ME
<br />gGNIFICMT PENALTIES FOR SUBMITTING FAISE INFORMATION
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<br />- THE POSgBIUTY OF HNE MD IMPRISONMENT. SEE IB U.S.C. E 1001 MD 39 BIONATURE OF PRINCIPAL EXECUTNE tn
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<br />TYPED OR PRINTED U.S.C. E 1916. //r/wN4. uqr Ww mron. rrMr •L,x•L.w. rws w ro ! l0,Op0
<br />srw nmvil,un inrdwmisara Mnrwn flm~rN.sM 6YSra/ OFFICER OR AUTHORIZED AOEM GODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/erencs sn sttecnmsn(s oars!
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<br />EPA Fam 3320.1 108-961 Previous edition9 may be used. (REPLACES EPA FORM T40 WHICN MAY HOT BE U6ED.1 ^ ., r . „ - ~ _ , PAGE OF
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