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<br />fealty Name/Lorntbn iJdiJJnent/
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<br />NATIONAL EO LLV TA NT DIIGNARGE [LIMIry AT10N iYlTEM //YFDE.S)
<br />DISCNARGE MONITORING REPORT IDMRI
<br />ale n.19-. ~ J ~ Form Approved.
<br />Co~::l]i~4 X17 .a j. - :% •r7 OMB No. 2040-0004.
<br />PERMIT N VMRlR OIECw,RGE HVM.ER - - i ~ s . ~ Approval expires 6-30-91.
<br />MONITORING PERIOD ~
<br />YEAR MO DAY YEAR MO DAY
<br />FROM )J V,. J1 TO JU L rU -7 :::•: li LiSi.LAi(Gc _ ' •: ](::
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<br />PARAMETER (3 Card Only) QUANTITY OR LOADING
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<br />AVERAGE
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<br />6163) ANALrsls
<br />(61681
<br />(69-711)
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<br />NAME/TITLE PRINCIPAL E%6CUTIVE OFFICER Kg50NALLr [xAMrNED
<br />CEgTIFV uNDEP PENALir OF LFw THAT .NAVE
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<br />ND AM FAMILIAq WITH THE INFORMATION SUBMITTED NEREIN AND BASED ~' TELEPXONE D A T E
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<br />ON MY INQUIRY Oi THOSE INdVIWAIS IMMEDIATELY gE5POH61BLE FOq
<br />OBTAINING TH[ INFORMATION I BELIEVE THE SV SHITTED INFORMATION
<br />IS Tm1E ACCVRATE AND CGMIPLETE I AM AWARE THAT THERE xR[ SIG
<br />11TTING FALSE INFORMATION INCLUDINL•
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<br />md... mnTm, wl wpn..mmnln,/b.m..n6m.mrn. and ;.br.l OFFICER OR AUTNORIZED AGENT AREA NUMBER YEAR MO DAY
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS lnr/errnrr mr uvuanmenD nr.q
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<br />EPA Form 7320.1 (flw. 9-BB) frsvloua Bditions may 6e used. ~ (REILACE! LPA FORM T-!0 WNICM MAY NOT i[ VSED.) ( r, ~ ' _- PAGE OF
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