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PERMITTEE NAME/ADDRESS 9vA4 F.eWryNa./Lrwm pDlO...,,q
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<br />LOCATION .S -,. J~`I ~ JJJ.. =S :~
<br />NATIONAL POLLUTANT DISCHMGE ELIMINATION SYSTEM /NPOESI Fonn Approved.
<br />DISCHARGE MONITORING REPORT (OMRI
<br />11-rsl n-r9l ~ , - -_ ~ ^ ; ~ _ , . -~ 6/OceMB No. 20,40-0004.,
<br />,~^; ~r '1'.n ~ (~1. ,Ii ,.,C) oJel aspires 05-31-98
<br />PERMIT NUMBER DISCHAiiGE NUMBER -~ ~ II I I II I II I II IIII III
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<br />MONITORING PERIOD '•I ~ -''
<br />YEAR MO DAY YEAR MO DAY OfV~SJ , _ .uvy
<br />FROM i9 C' JL TG 1: J~ :J .':^. .-. r,-rf..-~OPM/~p~` ~ :.. ~;
<br />!14111 /11-131 114151 /14171 119-291 /34311 NOTE:-Reed IneTructlaru balor'I~II~OtI)tD this form.
<br />PARAMETER l3 Grd Ontyl QUANTITY OR LOADING l4 Grd Onlrl QUANTITY OR CONCENTRATION ND FREQUE SAMPLE
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<br />AVERAGE
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<br />UNITS
<br />MINIMUM
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<br />MA%IMUM
<br />UNITS E){
<br />s ANALYSIB I
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<br /> MEASUREMENT
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EXAMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS
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<br />TRUE, ACCUMTE AMD COMPLETE
<br />I AM AWME THAT THERE ARE ~/
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<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ~
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.D. F 1001 AND ]7
<br />°
<br />SIGNATURE OF PIIINCIP
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<br />YtiI+Y. u.Nr NAM F61YM1F :+IFY ickW Firwa rm ro t/0.000 AL E7tECUTIVE ARE
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<br />TYPED OR
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<br />OFRCER OR AUEHORRED ADENi A
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
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<br />EPA Form 3320-1 108.95) Previous editions mey be used. IREPLACEB EPA FORM T40 WHICH MAY NOT BE USED.1 PAGE OF /
<br />~26'/97Gd11'-1~3= 1
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