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PERMITTEE NAME/ADDRESS pried. FrMryNaWfaaum rJD7pi...r)
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<br />NATIONAL POLLOFANT DISCNIUIOE ELIMINATION SYSTEM lIVPDf$l
<br />DISCHARGE MONITORING REPORT lOMR)
<br />11-161 I7-191
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<br />JPERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~~ ~ ~ TO t}
<br />/2621/ l12-13! l21-25/ !26271 /28-29/ 13631/
<br />Form Approved.
<br />OMB•No. 2040-0004- ••
<br />I , ~ ~. t Approval exPiiee OS-31-98
<br />NOTE: Reed inetruoUau be(a~ a letinp this lam.
<br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING I~ Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46531 !565/1 138-051 l0653J 154571 E DF
<br />l32-371 X YSIS
<br />ANIV TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS IFa-sal .
<br />154581 159-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY OF L AW THAT I HAVE PERSONALLY EItAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFO RMATION SUBMITTED HEREIN; AND 9ASED ON
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONABLE FOR
<br />P.ichard I`4III= OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br /> TRUE, ACCURA
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<br />SIGNIFICANT PENALTIES FOR SUSMI7TING FALSE INFORMATION
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<br /> THE POSSISIUTY OF NNE AND IM
<br />RISONMENT. SEE 19 U.S.C.
<br />001 AND 3] SIGNATURE OF PRINCIPAL EXECUTNE
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<br />TYPED OR PRINTED rNrmv.nurr irlprlaemwnr a/bNwnamm[M rqb y.ra! OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMCN 1 S ANV CArLFrvA I IVrv vT nlr T vw~n I wno Irtererence an srrecnmenrs nere/
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<br />Epp Fam 3320.1 108.951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 ,~ n ,t ,. ~ ~,, ~ r IL r ~ ~ ~ ~, .t _ PAGE OF
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