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PERMTREE NAMFJADORESS pnchde Feciliry NemrJ/ncndon /fDifferenr)
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<br />ADDRESS ; R ~ > i r ~ ' ~ : ^ •' - "r ~ w a . ., ;.
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<br />FACILfTY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES)
<br />DISCNARGE MONITORING REPORT (DMfl~
<br />(zae) nr- el
<br />-~~^77?SL' ^1t a
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ r ` TO '°" ^` '~
<br />(10.211 (YP.Y3l (14.451 (4E411 (48-491 (3601)
<br />Forth Approved.
<br />~ T ~ -, OMB No. 2040-0004
<br />Approval expires 05.31-98
<br />r~110'- 'J1
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<br />` A NOTE: Read Instructions before completing this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 4&53) 5487 (38-45) 48-53 54-Bf DC OF TYPE
<br />(3Y~n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~s3) ~ggLBB/S 69-70
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<br /> MEASUREMENT ~7 (p 3 (~ }Q 7/,~fO
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<br />NAME/TITLE PRINCIPAL IXECU7IVE OFFICER I CERTI
<br />AM FAM FY UNDER PENALTY OF
<br />ILIAR WRH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EXAMINED AND
<br />IN; AND BASED ON MY
<br />--- - TELEPHONE DATE
<br /> INOUIfiY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING /
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<br />P.Ichard PhlI15 THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, '
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<br /> ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTIN I AM AWARE THAT THERE ARE SIGNIFIGVfr
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<br />nvironrlerltDl A4ana or
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<br />Fpp Form 3320.1 (0$-95) Previous editlons may not be used. (REPLACES EPA FORM Tab WHICH MAY NOT BE USED.) ~ ^ r ,t 1 ~ ~ 7 ^ 4 { ~_ 1 ~ ~ IL PAGE r OF
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