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PERMITTEE NAME/ADDRESS o..rm rsmy.v...ira.nar dDl~.q
<br />NAME TF.APIF': "I' [ ;~.:. ::.~ .
<br />ADDRESS T H A P i> E' k" I :•
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<br />LOCATION
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<br />NATIONAL POLLUTMT dSCHMOE ELIMINATON SYSTEM /NPDf3/
<br />DISCHARGE MONITORING REPORT IDMRI
<br />l1-I6I I7-19I
<br />Cc,OJ3"1115 CC] f
<br />PERMIT NUMBER DISCHMGE NUMBEq
<br />' MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM 1 ~ TO ~ C [ -
<br />l?471/ I2T-I3) !II-151 /Ib?7I lIB-19/ !3431/
<br />CCKC Al0 TO
<br />(cI+PF T:J)
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<br />Form Approved.
<br />J 0 H N ~9't~ I'l4i~L~10004
<br />ApprovMlexp'Vaa-OS-31-98
<br />NOTE: Raad Inawatloro before complaUnp thin form.
<br />PARAMETE
<br />' f3 Ei.d onlvl QUANTITY OR LOADING !1 drd Onlyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE
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<br />lit-371 t.:
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<br />UNITS MINIMUM AVERAGE MAXIMUM UNITS rct-e]! MKY919
<br />(54-581 159-701
<br />0
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<br />c E'FLU E;NT L,kl;~ VALU. REQUIREMENT . ~: : as#,? ~ ~ ~ .Ct.T fi~ AYG ~t A.~I Ix Kx Mt;/L
<br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENN.TY OF
<br />AM fAMILIM WITH THE INFO LAW THAT I HAVE PERSONN.IY E%AMINED MD
<br />RMATION SUBMITTED HEREIN: MO BASED ON TELEPHONE DATE
<br /> MY INOUIRV OF THOSE INDIVIDUN.S IMMEDIATELY RESPON48LE FOq
<br />OBTNNING THE INFORMATION, 1 BEUFVE THE SUBMITTED INFORMATION 19 ~ _
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<br />W. Gordon Peters TRUE, ACCURATE MD COMPLETE. 1 AM AWME THAT THERE ME
<br />INCLUDING
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<br />P SUBMITTING FALSE INFORMATION
<br />P
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<br />President 6 General N7TI8 ei ,
<br />SIGNIFICMT
<br />ENN.
<br />IE
<br />O
<br />THE PoSSIBILITY OF NNE MDIMPNSONMENT. SEE 18 U.S.C.{1001 MD ]] i10NANRE OF rRINq-AL EXECUTIVE -
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<br />TYPED OR PRINTED .+srmM:,A.n:nF•%dm~Mrwe,rw..AeAHnn,.ns Fr,Fra/ OFFICER OR AUTHORIZED AGENT COOS NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRdersnn all attachments har~1
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<br />mey be used.
<br />EPA Form 3320-1 108-951 Previous adirions (REPLACES EPA FORM T40 WHICH MAY NOT BE UBED.1 D D G I G / 5 ] 1211-1.611 t PAGE .OF ,
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