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PERMITTEE NAME/ADDRESS pnr6d,srrGryN~/lx,nen dD}rmrl
<br />NAME Ci"37,:+'34•'7 YI LL"7 ~71L ~°~?D,
<br />ADDRESS Y>"i'f'~ 1r 7C? i~71i n.'.~ ;r F,^179A`l 7S
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<br />91`.'17 rAr_'C "T 'F~•.,t:- "'r;crLF
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT p19CNM0E ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT IOMRJ
<br />11-181 117-I9)
<br />^~lt~27 Lea 9'1q A
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM ~'t TO ''" _. '~.
<br />!16111 111-131 /?4-151 !16171 l18-191 !36311
<br />Form Approved.
<br />W• •~ r ~ r •.ny ~•+..OMB~No~2040-0004-~ ;-
<br />~r-tty- .~pl Approva4 eitpires 05-3~1-98
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<br />NOTE: Raad InetnECtione belore co pletinp this form.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46531 l5b51 138-451 !46531 ISbBII GF
<br />131-371 EX
<br />MALVSIs TV PE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.691 lfibSBl !53701
<br />-LJ "+_I l.'C°T. IPY SAMPLE .. a;: :: ;: :;::: .... ( '11
<br /> MEASUREMENT
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<br />FF't'LUf:'Jt ';'i')~S Vfl,eIF REQUIREMENT~ ItiST yAx. vn_:7 ~ .. "~
<br />NAMERRLE PRINCIPAL EXECUTNE OFFlCER I CERTFY UNDER PENALTY OF L
<br />AM FAMIUM WITH THE INFOR AW THAT I HAVE PERSONALLY E%AMINED MD
<br />MATION 9UBMITTEO HEREIN
<br />MD BASED ON
<br />' TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />l OBTNNING THE INFORMATON, 19ELIEVE THE SUBMITTED INFORMATION 19
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<br />En•7ironrlental ;•~anager TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIONIFICMT PENN.TIES FOR SUBMITTING FN.SE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE t9 U.S.C. E 1001 MD 37 97 D a~ D-2 E } 1 ~ ~ $ 9 t~
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<br />EPA Form 3320-1 108 961 Prsvloua edmone mey be used. (REPLACES EPA FORM T~tO WNICN MAY NOT BE USED.1 n'T ~ L 3 / ~ ~~ ~ I. ~ ~ - ? ~ PAGE - OF
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