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<br />FACILITY d
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNARGE ELIMINATION SYSTEM /NPOESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />n-ISi l17-191
<br />PERMIT NUMBER DISCHAIIGE NUMBFA
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM 'f '1 l.. TO "'~ ? .
<br />!26211 l12-231 !24151 126-271 l28-291 13631/
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<br />Form Approved.
<br />T nOMBfNoo 2040-0004r q
<br />Approval expires 0531-98
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<br />NOTE: Read inetrudiane~belors complatinq thu form.
<br />PARAMETER !3 Grd On/Yl QUANTITY OR LOADING !~ Grd OnlYl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> 146-531 154611 !3B-a51 146-531 15a-611
<br />EX of
<br />TYPE
<br />131-37/ ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e2-esl ly1-681 16g701
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<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY FxAMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON TELEPHONE DATE
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<br />Rlch:.rd I' MY INQUIRY OF THOSE INDIVIDUALS IMM WIATELY RESPONSIBLE FOR
<br />OBTMNING THE INFORMATION
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<br />SIGNIFCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 MID 3S SIGNATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. 1 1110. lPnW4• uMw era mnrr• nrY IxAMr rir• w ro S 10,000 AREA
<br />TYPED OR PRINTED rd ormuinun hrPH•alnenr erbMwnemoner•rM6 prAl OFFICER Oq AUTHORIZED AGENT
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRerersnce e6 attecnments oars/
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