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<br />NATIONAL POLLUTANT DISCH/JIDE EiIMINATION SY9TEM (NPOESI Form Approved,
<br />DISCHARGE MONITORING REPORT (DMRI , , ... ~ - ~ .OMB~No: 2040-0OORc v
<br />l1-151 (17-I91 ~ • '
<br />.. r ~ r ~ , ~. A .~, Approval exPiroe 06-31-98
<br />PERMIT NUMBER D19CHARGE NUMBER - •• -
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM ` ~ TO ~ ., , r , __ I
<br />l70-111 IT1-131 17415) 116-771 l18-291 1363/! NOTE: Read Irutructlale balsa completin0 thu form.
<br />PARAMETER l3 Ord Onlyl QUANTITY OR LOADING 11 Grd OnlYl QUANTITY OR CONCENTRATION NG FREOUENCV SAMPLE
<br /> !46531 151-61) 13B-15I !4653 1516/ DF
<br />l31-37/ EX ANALY919 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l67~531 (5<-581 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAA WITH THE INFO UW THAT I HAVE PER90
<br />RMATION 9UBMITTEO N NALLY ExAMINED AND
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<br />EPA Fam 3320-1 108.961 Previous editions mey be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.1 ~ _ _ ,~ ~ 7 , ~ -• _ t PAGE OF
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