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<br />NATIONAL POLLUTANT DISCHMOE ELIMINATON SYSTEM INPDESI FOFm ApprOVed.
<br />DISCNARGE MONITORING REPORT (OMRI 1
<br />17-151 17-19 ~, '' , ~ > L' •~ ~• OMB No/ 2040-0404
<br />ni ~ - ~~ ~ - ~ Approval a iree 05-31-98
<br />PERMIT NUMBER OISCMMGE NUMBEfl ~- _ _- ~ ~ ~ `
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
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<br />1147!/ l11-731 /Ia-75J 12677/ 129-791 1363f) NOTE: Reed Irntruetlwr b~fo.. completinp~thie form.
<br />PARAMETER 13 Grd On/YI QUANTITY OR LOADING /I Grd Ontyl QUANTITY OR CONCENTRATION NO. FREauENCr SAMPLE
<br /> I~6531 !5451/ I3B-!5/ 146531 15451 E% O V
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<br />137-371 M/
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<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS r6:-sal 164581 159-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 CERTI
<br />AM FA FI UNDER PENALTY OF
<br />MILIM WITH THE INFO lAW TNAT I HAVE PEflSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN; MD BASED ON - - ~ -,; ( TELEPHONE DATE
<br /> MY INOUIM OF THOSE INDIVIDUALS IMMEDIATELY RESPONABLE FOR
<br />_
<br />~ OBTNNING THE INFORMATION, I BEUFVE THE SUBMITTED INFORMATION IS -
<br />- TRUE, ACCURATE AND COMPLETE I AM AWME TNAT THERE ME
<br />SIGNIFCANT PENALTIES FOR SUBMITTING FMSE INFORMATION
<br />INCLUDING
<br />- •- _ ,
<br />THE P05981LITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. 1 1001 MID 99
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<br />~~ ~ EIONATURE OF PRINCIPAL EXECUTNE
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<br />Y,A•al OFFICER OR AUIHORI2ED AGENT AREA
<br />CODE HUMBER YEAR MO DAY
<br />GVMMtN I, ANN cnr~wnw I=vn yr wrv, vlvt,w I Iona mererence sn euscnmen=s oars,
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<br />EPA Form 3320-1 108-951 Previous editions may be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.) . , / PAGE 1 OF
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