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PERMITTEE NAME/ADDRESS psi,L Fe:duy NaW /amlon dDltl....q
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCXMOE ELIMINATON SYSTEM (NPDESI FDrm Approved.
<br />DISCHARGE MONITORING REPORT (DMRI .. _ - - BOMB No.-,,2040-0004
<br />11-761 177-191 '
<br />~ ? 7 1 ] r n ~~. ~ (._ „ . _ ~.. I Approval expires 05-31-98
<br />y ^PERMIT NUMBER DISCHNiGE NUMBER _
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY __
<br />FROM '. ;:1 TO -~ .i ')': i'1 ~:.. .. ._ T ;^ 9 : - . ;. ) __ ~ "`-': r.
<br />12o-111 121-131 174-251 !76171 118-791 136311 NOTE: Raed Inetructiane belors complatinp this form.
<br />PARAMETER !3 Grd only! QUANTRY OR LOADING !4 Grd On/y1 QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146531 15487/ 138-451 !46531 154-ell DF
<br />137-371 EX ANAirsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /F7-e]I 184-eBl 189-701
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF UW THAT I RAVE PERSONALLY EXAMINED AND
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN
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<br />MY INQUIRY OF TXOSE INDINDUALS IMMEDIATE
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<br />EPA Form 3320-1 108-951 PfeNOUB edmone mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) .
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