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PERMITTEE NAME/AODRE55 (IM~d. F•eWryNaailaanm l/Dlpnnq
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<br />NATIONAI POLLUTMT D19CHMOE ELIMINATION SYSTEM NPDESI
<br />DISCHARGE MONITORING REPORT ID Rl
<br />7-r61 17-191
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<br />PERMIT NUMBER DISCHMGE-NUMBER
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<br />YEAR MO DAY YEAR MO DAY
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<br />176211 /12-131 111-151 /76221 08-191 /30.311
<br />Form Approved.
<br />~AAB I[Jo. 2040-0004
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<br />132-371 EX MALrss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /e7-eel /6q-681 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE-OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF
<br />MILIM WITH THE INFO (AW THAI;I „~/E PERSONALLY E%AMINEp MD
<br />RMATION;9Ua9 ITTED HEREIN
<br />MD BASED ON TELEPHONE DATE
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<br />Mr INQUIRY OF THOSE INDIVB)UALS.~ I MEDIATELr RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19 j ~
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<br />- TRUE, ACpUMTE MD COMq.ETE. I AM AWME THAT THERE ME
<br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />EPA Form 3320- 10 -9 Pravloue a itlone may bd us CE8 F 4 ICH MAT NOT BE USED.I PAGE OF
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