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<br />NATIONAL POLLUTAYT OISCNMOE ELIMINATION SYbTEM lire/c.'ir Forth Approved.
<br />DISCHARGE MONITORING REPORT /OMRI MB,~Io.~04050PUr. "
<br />- ~^) T t - F r I •, ~ -• • ~ ~~ '~, APProval 1 %~i~ b5-31-96
<br />'PERMIT NUMBER DISCNIJIGE NUMBER _ =
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<br />YEAR MO DAY YEAR MO DAY
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<br />- /10.711 l77-731 !24761 12B-171 RB-191 /3631/ NOTE: Reed Nn4uetlaw bsfare~compilslin0 Ehls form. I
<br />PARAMETER t3 are OnNJ QUANTRY oR LOADING !t 6nJ OnNI QUANTITY OR CONCENTRATION N0, FREQUENCY SAMPLE
<br /> l~6531 l51-611 3B-I61 /16-53 5F61 EX TYPE
<br />l37-371 µALV95 +'
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS e7-e3i /yE.6s1 1s9-7ol
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<br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />MA FAMILIAfl WITH TNF INFO LAW THAT I HAVE PERSONALLY F%AMINED MID
<br />RMATION SUBMITTED NERDN; AND BASED ON ., ~ j
<br />/ TELEPHONE DATE
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<br />~ MY INOLVRY OF THOSF INDINDUALB IMMFDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATON, I BFUEVE THE SUBMITTED INFORMATION IB /, /
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<br /> TRUE. ACCURATE AND COMPLETE. 1 AM AWME THAT THERE ME ~/
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<br />J SIGNIFICANT PENALTES FOR 9UBMITTINO FALSE INFORMATION
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<br />I'y ~ I Il eE ` THE POSSIBILITY OF RNE MID IMROSONMFNT. SEE 10 U.B.C. 1 1001 AND as
<br />610NATURE OF PRINCMAL EXECUTIVE ~
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS 1Releronce es stleMmsnte here!
<br />EPA Fbrin"3320-T 106-96 Prsvioui editions mey be uss I ~ CE9 EPA FO T40 U/fl H MAY NOT USED.) / ~ PAGE OF
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