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<br />NATIONAL POLLVEMT DISCHMOE ELIMINATON SYSTEM INPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT lOMRI - - ~ OMB No. 2040-0004'
<br />lZ-161 117-191
<br />~, ,~ - ~ ~ ~ - q •. ~ r - . ' I Approval ezPiree OS-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER - ' ~ -
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM .. .' TO ~ - _. - _ _. I ~ ..:
<br />!167/1 lZ1-131 114751 !76171 l18-791 !363!1 NOTE: Reed Irutrucdom bsiore'eomplallnp this }orm.
<br />PARAMETER l3 Card OnlYl QUANTITY OR LOADING l4 Grd OnlYl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46-53 /54611 138-451 !46531 1546/1 of
<br />l31-371 EX MALrsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNI75 rs1-sal 164-661 16g7p1
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<br />NAMEITITLE PRINCIPAL EXECUTNE OFFICER I CERTFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN
<br />MD BASED ON TELEPHONE DATE
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<br />MY INQUIRY OF TH09E INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />EPA Form 3320.1 108-951 Previous editions may be used. /REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 .
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