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-[RMITTlE NAM EIADDR[e! (ILA[/Yd[ <br />F~eQfty NelnelLDnrbn If dlgerenr/ <br />NAMET _I I ~____ V y_-- __ - <br />wooREO:i:__i__~OL_i__ --_-- <br />-----~ ---_~'-_C-------- <br />-ACLLITY _ _ _ _ <br />LOCATION _---_-_-__--___------ <br />NATIONAL FOLLY TANT OIICM LARGE [LIM INATION EYSTCM (NPUESI <br />DISCHARGE MONITORING REPORT lDMRI <br />1-/6 !~ <br />y PERMIT NUMe1CR olsc.^RSE n~M esw <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO PAY <br />FROM l r _ _ _ TO ~ ~ _ ~ <br />nnorl rn.]rl fvoal nx. nl na. ]a. rrn. rrr <br />Form Approved. <br />t - • ^ ! OMB'No.~2040-0004. <br />- . , .. .Approval expires 630-91. <br />NOTE: Read instruetiom before eomDletinD thif form. <br /> (J Card OMy) QUANTITY OR LOADING (1 Card Only) oU ALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(16-J3) (JIG/) <br />(JH-IJ) (1613) (7141) <br />NO. 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S&&ax <br />NAME/TITLE PRINCIPAL ExEC UTIVE OFFICER r cEgnlr unocw {EnwLTr OF Lww TXAT I Hwv[ PERSONALLr ExwE1w[D ~ - <br />/1 TELEPHONE D A T E <br /> AND LAM iAMILIwR WITH TNC INFORMwTION SUBMITTED XEROX LAND eLSED <br /> <br />".~ 1, <br />i-IcI;;I rLJ ly{I'I~ ON MY INQUIRY OF TXOSE MOINDVALi IMMEpAIELY RESFpI519LE FOR <br />OBTwINING THE INFOgMATIO.`I I BELIEVE TNC SVBMITTCD IXFORMwTION ~ ~ / ~ <br />^~ <br />~ <br />~ ~ <br />/' <br /> <br />IS TRUE. wCCUR4E IND COMPLETE I AM AWwgE TNwT THERE wRE SIG / <br />/ / <br />/ <br />~ <br />~ <br />M1 <br />L'T `JIYDfI r'-"` I <br />men <br />il+~~r <br />1 " NIFICwNT PChALTIES FOR SUBwIT11NG FIASE INFOIIM6TIQN INClVO1NG ~ r / r (I <br />Ic~nT~~ <br />~,~~~ <br />r•) - 1~ <br />.:_ <br />. THE POSSIBILITY OF FINE AND IM%11$ONMENT $EC IB USC 1 IODI AND <br />]] VSC 11319 rM <br />le <br />M <br />N <br />M <br />SIGNATURE OF PRINCIPAL E%ECUTIVE `~ ~V JV <br /> <br />TYPED OR PRINTED na <br />r. ~ <br />rr <br />rv <br />mmra m mrludr /mr. •y u. tllr axl <br />ar <br />o•dr.rma.mmm rnrprnimnr.v../Mluvnfim.rnrh. and 3.rrvr.r <br />OFFICER OR AUTNORREO AGENT <br />A EA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />EPA Forili 332a1(Rw.Y3B)-P!lv1oO8 Btlitioris-Tray be bled. (REPLACES eFw rowM r•eo wNlcN Mwr NOr eE UacD.l _ Pwse of <br />V- a ~- i - J 1 ~ __ <br />