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<br />LOCATION
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATON SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />1-161 I7-191
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM ~p 'f, }L TO ~ y~ ~?
<br />126111 l12-731 !74761 116-171 116-191 1343!/
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<br />Form Approved. ~
<br />OMB No..2040-0004 ~
<br />Approval etipiree'05-31-98
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<br />`NOTE: Raad Inetructlars betora'cdlrtpletln0 thu form.
<br />PARAMETER 13 Grd Onlrl QUANTITY OR LOADING !1 Grd Onlrl .QUANTITY OR CONCENTRATION Np, FREGUENCr SAMPLE
<br /> 146-531 !54611 138-45/ !<653 /54-6E1
<br />EX OF
<br />l32-371 ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s=.631 !54581 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cl[RnFr UNDER PENALTY OP uW THAT 1 HAVE PERSONALLr ExAMINED MD TELEPHONE DATE
<br /> AM FAMIl1M WITH THE INFO RMATION SUBMITTED HEREIN; MD BASED ON
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<br />1 MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />~~ )/L/1~ '_ OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS -
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<br />SIGNIFCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />THE POSSIBILITY OF RNE MD IMPNSONMENT. SEE 16 U.S.C. ! 1001 MD 33
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<br />TYPED OR PRINTED .neormuwwn inFVidurwtr Or Mrrwn e,~A,er.wsw.ral OFFlCER OR AUTHORIZED AGENT
<br />CODE NUMBER YEAR MO DAY
<br />COMMEN75 ANV CAr'LANMIIVN Vh ANT VIVLAIIVNJ IRB/6/B/ICB a//6R6MTMIS Oe/e/
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<br />EPA Form 3320.1 108-951 Pravioua editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ~ _ L, ~ ! ~ ; ,: - _ ~ 1 ~ _ PAGE ~ OF
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