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PERMIT'TEE NAME/ADDRESS peFifsWnNr'Locnla. l/Dl~ rwq
<br />NAME TWAPVF.R ~Iyi`IC, 7NC.
<br />ADDRESSTRAPPPR •I`1!'
<br />P.O. PST 1'17
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<br />FACILITY
<br />LOCATION
<br />'~2IV: ti. GOS1~7S Pt'TERS, S'ilE'.!" ~ rGA
<br />NATIONK POLLUTMT g9GNM0E ELIMINATION BrS~EM /NPDESI
<br />DISCHARGE MONITORING REPORT /OMRI
<br />T-/6l 17-191
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<br />`PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEA ~ MO D VE D
<br />FROM TO '
<br />170-21) ITT-73) ITS-?51 125-T71 118-T91 130-3T/
<br />Fonn Approved.
<br />M I R 7 R OMB No. 2040-0004
<br />(S n 9 A !! Y) Approval esspirae 06-31-98
<br />BLS,^i?'. ~CF, ^0 "OTOTv GULCr' '
<br />NOTE: Reed Instrucriaw bdas camplstinp this lam.
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I LERTIFr UNDER PENKTY OF LAW TNAT I NAVE PERSOMALLr E%AMINED AND
<br />AM FAMILIM WITH THE INFORMATION sUeMITTED HEREIN: AND EASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDINDUKS IMMEDIATELY RESPONAELE FOR
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<br />EPA Fam 3320.1 (08.96) Previous editions may be used. (REPLACES EPA FORM 740 WHICH MAY NOT BE USED.) n U!! 1 R / 7 7 ^ q ? 2-! 0l q PAGE I OF Z
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