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PERMITTEE NAME/ADDRESS PrArd. FrWryNSWLxenon UDId r.np
<br />NAME ;;V 1 .' ~ _ .. '._ .
<br />ADDRESS Ai, /. ° - ~ ~ ' ~ ~ r , .., ,
<br />• 5:.x.1 ,,• ~^ T" - '~f, i
<br />,lf -..
<br />FACILITY
<br />LOCATION
<br />r~~.. ,.rtt,r ,~ ~,,~~, se1~L ar~Y
<br />NATIONAL POLLUTANT OISOHMOE EDMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />17-76'1 117-191
<br />'~J271i!1 rn~ q
<br />PERMIT NUMBER DISCHNiGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM 'i TO '"'. .. 1
<br />120.2/1 l12-731 (74251 126-771 129-291 (363/1
<br />/a•1rc Bv?
<br />C - C T • 1 >I {
<br />~/`~
<br />Fonn Approved.
<br />..~,~OMB1No.12040-00040 -r
<br />Approve! explrps 05-31-98
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<br />NOTE: Rsed Inatructlone balors comPlatinp this lorm.
<br />PARAMETER !3 6rd Onlld QUANTITY OR LOADING !I Grd On/Yl QUANTITY OR CONCENTRATION NO, mEOUENCY SAMPLE
<br /> 46-531 !546// 138451 !06-53 154611 GF YP
<br />l37-37/ EX
<br />ANALYSIS T
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167.6]! !64681 !6&701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDF11 PENALTY OF UW TNAT I HAVE PERSONALLY E%AMINED AND TELEPHONE DATE
<br /> AM FA MILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION
<br />I BEDEVE THE SUBMITTED INFORMATION IS
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<br />ACCUMTE AND COMPLETE
<br />I AM AWME TNAT THERE ME
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<br />SIGNINCIWT PENALTIES FOR BUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />F TIV~rOli9PTlt8~ ~'~Q'lcger ,
<br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE IB U.S.C.11001 AND 3]
<br />610NATURE OF PRINCIPAL EXECUTNE 7U BBO-~7~Z ~ ZS 99
<br />TYPED OR PRINTED U.S.C. f 1]ta. /AVtM1YA uwr N.r mron, rneY hcanle Fnr. w ro s IO,OW
<br />rWrmuNnAn 1•nP'lmranr elbnren 6mandMW61w..1 OFFICER OR AUTHORD:ED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS ANV CAYLANAIIVN Uf ANT VIVLA IIVNS lrra/BlIOCB a//aReCATenTa natal
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<br />EPA Form 3320.1 106-961 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 r n 1 , ., ~ ~ , r!, , ~ _ T ~ .{ ., PAGE , OF
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