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PERMITTEE NAME/ADDRESS l1•d,4 Frl]ryNa/fa•ne•dOrDi.arl
<br />NAME :. i. I. '.F ~- _..4"•r.: i.. ISL.
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<br />ADDRESS [; i .. I _ ~ ; ( ~ ,} ~ ~,: r
<br />LL,I_..,,.'r _J 1.'L..~
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHAl10E ElIMINATON SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />l1-I61 lI7-191
<br />PERMIT NUMBER DISCHARGE NUMBEfl
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ a~ • J TO ,. v ~„ .: _
<br />114111 l11-131 111-151 !1617/ !IB-191 !34311
<br />Form Approved.
<br />.. ~.... i - ,1: i. ". .OMB No/ 204p-C700~
<br />( ... _ t~ Approval eXSilise 05- '98
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<br />NOTE: Reed Inetruetlone belae~Ntlnp thu form.
<br />PARAMETER !3 Grd On/Yl QUANTITY OR LOADING !1 Grd On/YI QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46531 l5b611 !38-15 !46531 151.6/1 OF
<br />l31-37/ EX ANUrss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS t1:-e.Tl !54681 169701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDE/1 PENALTY OF LAW THAT I HAVE PERSONMLY E%AMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN
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<br />ED TELEPHONE DATE
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<br />MY INQUIRr OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOfl _
<br /> OBTNNING THE INFORMATION, 1 eEUEVE THE SUBMITTED INFORMATION IS
<br />.,- TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ME ~
<br /> SIGNIFICANT PENN.TIES FOR SUBMITTING FUSE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF FNE MID IMPRISONMENT. SEE to U.S.C. ! 1001 AND 3]
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<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
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<br />DAY
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<br />EPA Form 3320.1 108-951 Previous editions mey ba used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ~ 1 ~ I. / , 7 ., ,, 1 ~ _ t ~ , I PAGE OF
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