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PERMITTEE NAME/ADDRESS p.rYLFrWryNaNlaenm dDr6r.e.e
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<br />ADDRESS IL ~'-. :r ~.;3 C7.~~•'.r r.. ,'~~,r 7•. n;
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<br />FACILITV
<br />LOCA-TION
<br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM INPDESI
<br />DISCEiARGE MONITORING REPORT (OMRI
<br />l1-151 17-191
<br />r~7-7)S:J f~7n
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD .
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~i ~ _`J ,1 _ TO '~~~ '1~ -''.
<br />Un-J l1 UJ-131 114151 /14171 118-191 130-311
<br />Form Approved.
<br />- - ,-.. .- -OMB.No.~2040-0004
<br />f r -, , , : > ~ APProval exP.irea.05-31-96
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<br /> !3 Ard On/yl QUANTITY OR LOADING !I Grd Only) QUANTITY OR CONCENTRATION r NO FREOVENCY SAMPLE
<br />PARAMETER 146-531 !545/1 138-e51 !16531 154611 .
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<br />137-371 ANALrss TY
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS r6J-eel !64681 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />AM FAMILIAR MATH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MY IMGUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />I eEUEVE THE SUBMITTED INFORMATION IS
<br />OBTAINING THE INFORMATION ~~
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<br />I AM AWME TNAT THERE ME
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<br />TRUE, ACCU
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<br />RCANT PENALTIES FOR SUBMITTING FALSE INFORMATION iLN '
<br />Environ:~srtt.l r~an~ger ,
<br />SIGNI
<br />TMEPOSSIBILITYOFRNEANDIMPNSONMENT.SEEIeU.S.C.Il001ANDJ7 610NATUflEOFPf11NCIPALE%ECUTNE 970 fl70-7.712 5 21 9'~
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<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS /Rs/scenes sl! stfechmsnts hare!
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<br />EPA Fwm 3320-1 106-951 Previous editions mey be used. IREPLACE6 EPA FORM TAO WNICN MAY NOT BE UfiED.I ^ _ ~ r y r , ,~ -, ~ 1 „ PAGE . OF
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