PERMITTEE NAME/ADDRESS (IMib FrWryNsWLxnrwr l(D+pawp
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<br />FACILITY
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<br />NATIONAL POLLUTMT DISCHMOE EDMINATIOM SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />17-161 117-191
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM "~ t - TO ~ '' 4 "'
<br />1147/1 l72-731 124251 /16171 l78-29/ 134311
<br />Form Approved.
<br />. • - . - - - ~ ...OIdB.No. 2040-0004 -
<br />t _ , ,~ „ ~ ~ , Approval expi~ a 05.31-98
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<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING I4 Grd On/Yl QUANTITY OR CONCENTRATION NO. FPEOUENCr SAMPLE
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<br />EX OF
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<br />l32-371 MAlrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs7-ssl !ee-6B1 159-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEMKTY OF
<br />AAI FAMILIM WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />I OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />TIES FOR SUBMITTING FALSE INFORMATION
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<br />• THE POSSIBILITY OF RNE MDIMPRISONMENT. SEE IB U.S.C.f 1001 MD3] BIONATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. 1 t ate. IPerWOi. uOA- Mw mnm. ArY MrcNM rxwa w ro t 10,000 AREA
<br />TYPED OR PRINTED .,.d armuhwninAn'>~.rIrNW6rnvrn smmFhaeMeywal OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Relerenee a//attachments here)
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<br />EPA Form 3320-7 108.951 editiona may be used,
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