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PERMnTEE NAME/ADDREBB R~birufryN~rlos+na. dDfeh.ne NATIONK -OLLUTMT DISCNMOE ELIMINATON BYHTFM //NPOfSI
<br />NAME ~ DIBCHAROE MONITORING REPORT OMRI
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<br />ADDRE88 N~" r: ;, F. :'•7t,r ^~nnnnani. anf 1
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<br />FACILITY , .~ . _ , MONITORING PERIOD
<br />LOCATION ~f~ M YEAq MO DAY YEAR MO DAV
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<br />Form Approved.
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<br />(~ 1, 11 n ,_ F' Approve jexpj~o 05=31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING I~ brd Onhl QUANTITY OR CONCENTRATION ND FREDUENCr SAMPLE
<br /> /16-53 54.61 38-15 /4653 /51-5/ OF
<br />137.371 E% MKr31S TYPE
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lszaa 161-691 159.701
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<br />NAME/i1TLE PRINCIPAL EXECIlTNE OFFICER I CERTI Fr UNDER PENKTY OF UW THAT I NAVE PERSONKLr EXAMINED MD TELEPHONE DATE
<br /> AM FA MILIM WITH TNF INFO RMATION SUBMITTED HEREIN; MD BASED ON
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<br />l MY INQUIRY OF THOSE INDINDUK9 IMMEDIATELY RESPONSIBLE fOR
<br />OeTAININO THE INFORMATION
<br />I efUEVE THE SUIMITTED INFORMATION IS "-~ i
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<br />SIONIRCMT PFNKTIE9 FOR SUBMITTING FKSE INFORMATION
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<br />THE POS9141UTY OF RNE MD IMPNSONMENT
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<br />D 77 fIONATURE OF PRIN
<br /> V.S.C. E t7tE. IFM•fe++ utlo ei.~ mflma.fl.r ax/w. Fxa+ w ro t 10,000 CIPAL E%ECUTNE
<br />TYPED OR PRINTED .naNllrrirx.ll ifrpbpnwlr orawwnerlle,n, arger.r.l OFFlCER OR AUTHORRED AGENT CODE NUMBER YEAR MO DAY
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<br />EPA Form 3320-T 10&95) Provioue editiom mey be u3ed. (REPLACES EPA FORM T-40 WHICH MAY NOT 8E UBED.I Q~U l~ ~I ~ a h a ,; i , _ :. , , PAGE TOF
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