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PERMITTEE NAME/ADDRESS pi.eWi FrdnyNr/Lecmla BD~arU
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<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM /NPDE$I
<br />._.. OISCNARGE MONITORING REPORT (OMR1
<br />l1-161 l17-19I
<br />^ PERMIT NUMBER DISCHNIGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM ,; +~, TO -~ „ r)
<br />130.311 /33-331 l14I51 116771 !TB-T9l 130-3I1
<br />Form Approved.
<br />FMB No. 2040-0004
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<br />NAMERITLE PRINCIPAL E)(ECUTIVE OFFICER I cERn
<br />AM FA FY ur+DER PENN.n DF
<br />MILIAR WITH THE INFO LAw THAT I HAVE PERSONALLr ExAMINED AND
<br />RMATION Sl1eMITTED HEREIN; AND BASED ON TELEPHONE DATE
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<br />~ MY INOUIIIY OF TNOBE INDINDUKS IMMEDIATELY RESPON9BLE FOR
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<br />~ OBTNNINO THE INFOWAATION, I BELIEVE THE SUBMITTED INFORMATION IS /
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<br />- TRUE, ALCUMTE AND COMPLETE. 1 AM AWARE THAT TNERE ARE
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<br />" -i THE PoSABILITY OF FNE AND IMPRISONMENT. SEE 18 U.S.C. ! 1001 AND JJ
<br />BIONATURE OF PRINCIPAL E%ECUTIVE ~ •
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<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLANA710N OF ANY VIOLAf IOn~ llrererencs an srtecnmenrs nere/
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