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<br />NATIONAL POLLUTANT DIBCHAROE ELIMINATION SYSTEM INPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT IDMRI OMB~No..2040-0004
<br />/1-161 17-191 -
<br />l "` ' T 1 - T r . ~ ~ . APProve4 expires OS-31-98
<br />PERMIT NUMBER DIBCHARGE NUMBER _ C • +I + • ~
<br />MONITORING PERIOD ~; 1~TD
<br />YEAR MO DAV YEAR MO DAY _
<br />FROM ~ TO ~ - -~ I '
<br />!26711 ITT-T 31 (11-751 !76171 !TB-191 13P3/1 NOTE: Raed ImlructloFN before complstin0 this }orm.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> !46.531 !54.6/1 138x51 !46531 156-611
<br />EX of
<br />137-371 ANALrsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 16=.sal ly1-68) 16s 7o/
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<br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED AND
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<br />THE POSSIBILITY OF RNE AND IMPIIIBONMENT. BEE 18 U.B.C. 1 1001 AND 3] r ~ I v -
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<br />TYPED OR PRIN .eermuirmn irWalenwN a/berwnemmNa r106 yeFrtl OFFlCER Oq AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rs/erenee a//sttechments here/
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<br />EPA Form 3320.1 108-851 Previous editions mey be used. /REPLACES EPA FORM T-4 MAY NOT BE USEO.1 ,t „ „ /,~ ~ I ^ 7 _ t ; ; ,1 ~ PAGE OF
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