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PERMITTEE NAME/ADORE66 (/,ri,drirWryNuW/au.m /DI])fmn)
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<br />NATIONK POLLUTMT OISCHMGE EUMINATON SYSTEM lNPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT IOMRI .. Y .. ,. ~ ~ ,. ~,OMB•No: 2040-0004- F•
<br />1-161 I7-191 ~ r '
<br />- • ~ , • . I - / - .. -. ~: APProvel, a:pirea OS-31-96
<br />PERMIT NUMBER DISCMMGE NUMBER ~• - - -
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV ~
<br />FROM ' '- ~ . TO ~ ... ... . - , .... 1~1 : L. t.
<br />!161/1 l11-13) !10.151 !76171 l18-191 136311 NOTE: Reed InetructlarN befo com htln0 !hie torn.
<br />PARAMETER 13 Grd OnIY! QUANTITY OR LOADING !4 Grd OnIY! OUANTITV OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> 146531 15s-6/1 138-~51 1e6531 154-611 GF
<br />l31-371 EX
<br />MALYSIs TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS IsZ-6]! (66681 !6&701
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF UW THAT I HAVE PERSONALLY E%AMINEO MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON
<br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />l! OBTAINING THE INFORMATION, I BEOEVE THE SUBMITTED INFORMATION IS
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<br />. TRUE, ACCURATE MD COM0.ETE. I AM AWME THAT THERE ME
<br /> SIGNIFCMT PENALTES FOR SUBMITTNO FALSE INFORMATION
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<br />THE POSSIBIOTY OF RNE AND IMPRISONMENT
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<br />EPA Fwm 3320-1 108.95) `Previous editions may be used. _ IREPLACE6 EPA FORM T-40 WHICH MAY NOT BE USED.1 , , ,~ 7 ~ r . , .T _ . PAGE OF
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