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PERLRTTEE NAME/ADDRESBl/.d,d. F..-YrryNan/fuanen UDr~b.n,e
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<br />NATIONAL POLLUTANT DISCMMOE ELIMINATON SYSTEM /NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT fOMRI
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<br /> YEAR MO DAV YEAR MO DAV
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<br /> 13 Grd Ontyl QUANTITY OR LOADING !4 C•rd Onlyl QUANTITY OR CONCENTRATION NO, FREQUENCY SAMPLE
<br />PARAMETER !46531 !5661) l38-451 !4653 1546/1
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<br />TYPE
<br />131-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (61.691 ANAirsls
<br />!Bq-Bgl 169-701
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<br />NAME(TITLE PRINCIPAL E%ECUTIVE OFFICER I cERnFV UNDER PENUTY QF uw THAT I HAVE PERSONALLY ExAMINED AND
<br />BMITTED HEREIN
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<br />AM FAMILIAR WITH THE INFORMA
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<br />MY INQUIRY OF TMOBE INOIVIDUAlS IMMEDIATELY RESPONSIBLE FOR /
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<br />I (- OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 16 -
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<br />' TRUE. ACCUMTE AND COM0.ETE. I AM AWME THAT THERE ARE
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<br />SIGNIRCANT PENALTIES FOP BUBMITTIMG FALSE
<br /> THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE le U.B.C. E 1001 AND ]3 SIGNATURE OF PRINCIPAL E%ECUTNE
<br /> U.S.C. E 1 ]t e. IMWei• oleo dNr mnn•s rrNY AxAd• rvN• w ro S 10,000 AREA
<br />TYPED OR PRINTED •rMnm.rinun irw'la<w,w,r ol6•M•rr6mmrea •rW6yva/ OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS (Reference sll etteenments nerel
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<br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T-0O WHICH MAY NOT BE USED.1 PAGE OF
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