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<br />PERMITT'EE NAME/ADTDRE55 (Ikbdr rrtllryNaWLerq/w Ubl~rr0 NATIONAL POLLUTw~? DI9CHMOE ELIMINATON BY9'FEM U~,S/ ~ - t I ~p/m Approvqepd. '
<br />NAME I ~ ~ ~ ~ ~ ~ DISCHARGE MONITORING REPORT !D '; ~ ~ M~ ~Jo1~040=00~
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<br />jOU 3~ [iih uLYG. E JU(TC 4uU PERMIT NUMBER DI9CHMG NUMBER ~ - }=j1.AL -
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<br />FACILITY ~ MONITORING PERIOD
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<br />LOCATIOF~.LUM1~! : CL i1::LLS fROM U U TO D 6 3 s`k'i i.L uj xnAr Lc' ~~ {`¢{'
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<br />PA[iAMETER !3 GrdOMyl -QUANTITY OR ~OADINQ,: !e GN Onlyl QUAN~IjY OR~DONCENTRATION ~ NO, FREOUENCr SAMPLE
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<br />~. AVERAGE ~ MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e7-esl /5r-5g1 !5&701
<br />.1~ AIVU ~RLASE' SAMPLE i~4f$~ 94 fM4#k>p fi+Y5bv4K• ': :•#+{•;•
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 ~eERTIFr uNOen PENN.TY of LAw TNAT I NAVE PERSaNALLV ExAMINED ANO TELEPHONE DATE
<br />AM FAMlllµ N'~TN THE INFORMATION SUBMITTED HEREIN; µD eA9ED ON 1~
<br />MY INOUIIIV OF TM09E INDIVIDUN.9 IMMEDIATELY nESPON9IBLE FOR '
<br />%~I~~ ~-Ir ~ \,-_~ H f"'~ ~JL!{ j(,e~ OBTNNINO'THE 1p F011MATION, I .9EUEVE THE SUBMITTED INFORMATION 19 I
<br />I- TRUE, ACCUMTE µD COMPLETE. I AM AWARE TNAT TNERE ME - t ~',`~~ '~-~ -r(~ mil; ~--
<br />' SIONIFICµT PENAL T1E5 FOR SUBMITTING FALSE INFORMATON, INCLUDING ~' ~~ ~ ~ I' -r ~ L ~~
<br />j (~ ~ !:. ~-~ ." ~, /I - THEP0591BIDTY OF FINE µD IMPPoSONMENT. SEE te_U.9.C. 1 1001 µD ]] BIONATURE OF PRINGPAL EXECUTNE r / ~ ~ ' ~ ~ ~ ~ , '
<br />U.S.C. 1 1 ]1 B. lHrrWW ~N.r N•r mNna m•y ic.Ors• 6r• ye ro t 10.000 AREA
<br />TYPED OR PRINTED •iNu•mrh••n hprlrmwe•I brAr•.nemonee rNe wr+.l OFFICER OR AUTHOPIZEO AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRelerencs ell stteehments here! ,
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<br />EPA Form-3320-7 108-951 Previous editicn9 rney be uea ~ ~ 1 CES A FO ~ HICH MAY NOT BE USED.) PAGE OF
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