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PERMITTEE NAME/ADDRE550+rb4 FrNnNaW/ocanw dDlC•r..p
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<br />ADDRESS `4I `+-~ 1, ~' 3 :: G'1'"',, P Fi; N!l P:N P4
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<br />NATIONAL POLLUTANT DISCNMOE ELIMINATON SYSTEM (NPDES/
<br />DISCHARGE MONITORING REPORT IOMRJ
<br />17-161 17-191
<br />'J0027i~1 ^'1 '1 ?
<br />PERMIT NUMBER DISCMMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO OAY YEAR MO DAV
<br />FROM 1 3 •11 .1 - TO 'tN ryq !'7
<br />170-7J1 177-731 !14751 176771 28-791 I3P3I1
<br />Form Approved.
<br />, - •• r ~ r ~. ^ ti „ r ml.OMBtNo:.2040-0004.- 4
<br />F,. •. -, , ~ 1 APProve, exPifes OS-31-98
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<br />`NOTE: Raed Instructlom befor~'eo ~ latlnp thu form.
<br />PARAMETER !3 Card OnIYI QUANTITY OR LOADING !4 6rd OnlYl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46531 154-6f! l3B-15/ !4653 /5451) DF
<br />137-371 EX
<br />MA1Y515 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l51~51J l545B1 159-701
<br />rr1 SAMPLE :;:}»rthA .-r, :~:': -, .. ( 1 ~)
<br /> MEASUREMENT
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<br /> MEASUREMENT
<br />.J li '~'l] !1 0 7 PERMIT S: r.`#$6F# "R:=»"~"- ., k#~.`^^i: grnrf: .n ..l~h ii}/ .41"'
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<br />~'U~uS 1 :1 PERMIT C:F»3k »1„'kxC;`- : `C` .'.":fi, »rP^~nn R^.,~nm r !.,rr/ •-rto
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<br />i!. .. ~ ';?F.1~_ SAMPLE .«(: ;:',::e':: .+###fir: t,: ,k:;::}t`r= s:Y#te r:' ( 1q~
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<br />;J~~i 1 J '' ~ PERMIT -.•~.. ##~:#?:- ;t ".k Y#rtA..r,` ,.. ~;Yyf T^ ~tY?r,+ •aM1 •,
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF L AW TNAT 1 HAVE PERSONALLY EXAMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITN TMF INFO RMATION SUBMITTED NEREIN; MD BASED ON ,
<br />A)~IIS
<br />kichard i MY INQUIRY OF TNOSE IMOINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />i TRUE. ACCUMTE MD COMPLETE. I AM AWME TNAT THERE ME
<br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br /> THE POSSIBILITY OF RNE MD IM%USONMENT. SEE to u.S.C. f t001 MD ]] 610NATURE OF PRINCIPAL EXECUTNE
<br /> U.S.C. f 1]le. IFMtMFi. u!u dwr mNhr nvY Nlchd~ ~ + up Ib s IO,OOD AREA
<br />TYPED OR PRINTED tl1/Y'/n[f~IR/n.'RMAP'YIMIO/awwT S,,,rA,d,..,de yAril OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !RS)srence en ettscnments here/
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<br />EPA Form 3320.1 108.951 Previous tNlltions mey be used`. ^ IREPLACEB EPA FORM T40 WHICH MAY NOT BE USED.1 „„„., ~ / ~ ,. _ T ~ PAGE OF
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