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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR~
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ' ~' ~' I TO ° ~' ° '
<br />(2P21/ T12-231 (24251 (26-211 (2B-2B) !3691)
<br />Form Approved ,
<br />„ ~ T ., .. OMB No. 2040-0004
<br />Approval expires Orr31-g8
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<br /> (3 Cent Ony) QUANTITY OR LOADING (4 CVd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 46-53) 54-6T (38-45) (46-53) (5481) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAMElTITLE PRINCIPAL E7(ECUfIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />AM FAMILIAR Wmi THE INFORMATION SUBMITTED HERE NALLY E%PMINED AND
<br />IN; AND EASED ON MY TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON
<br />THE INFORMATION, I BELIEVE THE SUBMITTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE,
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<br />I AM AWARE THAT TH ERE ARE SMaNIFlCAM ~
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<br />PENALTIES FOR SUBMffTING FALSE INFORMATIO N
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<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEEIBU.S.C.41001PND33U.S.C.
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aelerence ell attachments here)
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