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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNNiOE ELIMINATION SYSTEM (/JPOf$l
<br />DISCHARGE MONITORING REPORT lOMRI
<br />II-161 117-191
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<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM '/ ~.. TO "+ ~ '
<br />/]6]rl !1]-]31 /]L]51 06171 !]g-191 !3631/
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<br />Form Approved.
<br />..,^OMB,No~2040-0004,..
<br />APProve4 a~Plrea OS-31-98
<br />NOTE: Read Inetructlme before completing this form.
<br />PARAMETER l3 Grtl OnlYl QUANTITY OR LOADING 11 Grd OnlYl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS less]/ !µ5g1 !53701
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENUTY OF UW THAT I HAVE PERSONALLY EAAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON
<br /> MY INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOR
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<br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.) I, _` ~~y ~ / • ~ r,I ~.~- = ^ , „ PAGE OF
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