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PERMITTEE NAME/ADDREBSp~4FrWryNar'laanm tJDMfnn.Q
<br />NAME C9t'~7S Jr. y-,a `74L1'Y :`dL '-;1'~~a
<br />ADDRESS vl 1 : ~ ,' r ) r ? : l S (11! T ! r ~. - ', ~ < A V P
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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLOTANT DISCXMOE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONfTORING REPORT (DMRI
<br />l1-161 /17-791
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM / TO " '~ - '
<br />!1621/ l12-231 121-261 /16/71 !IB-79l /36311
<br />Form Approved.
<br />„~ :• n c r ~ a ~ r m • r- •r T o,MB No:, zoao-oooa
<br />(,.,I r.- ~,.1 ADProvel ejCRirPe 05-31-98
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<br />NOTE: Read instructlorr balore'co plating this form.
<br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !1 Grd On/YI QUANTITY OR CONCENTRATION NQ FREOUENCV SAMPLE
<br /> /OE531 !50.611 l3B-151 lIG631 150.6/1 X DF
<br />l32-371 E
<br />ANALYSIS TVPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s2-s.Tl tlse-eBl 169-701
<br />..r f'::C= 5pt r," 70'Y SAMPLE .. :.};-.- ., F'Y :`. Cr >".. ..w-;. ~.: r ^T1
<br />}, It ~ I. ~ I (] i. ~, ~~ 1 :.. r MEASUREMENT
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<br />NAMERRLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASEO ON
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR / " "~
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<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />EPA Form 3320-1 108.95) Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1
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