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PERMITTEE NAME/ADDRESS (1rA4 FrWry NadLr,uen lJDld,.,wl)
<br />NAME .. .. .. - - .-_ _ •-.'
<br />ADDRESS ~TIL .. i I . ~ i ': iI ' r _ . ~~ •.
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<br />FACILITY
<br />LOCATION
<br />NATIOMM POLLUTANT DISDNAROE EUMINATON SYSTEM INPDES/
<br />DISCHARGE MONITORING REPORT IDMRI
<br />l7-Igl 17-1e1
<br />^^7?717a ,;~,
<br />V PERMIT NUMBER DISCNARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM " +1 TO ~ J~- ',.-
<br />/I61f/ l17-131 /7/-75/ !7677! !IB-79/ 130-37/
<br />Form Approved.
<br />- - ~ - ~ -.,OMB-No.-2040-0004 ,
<br />' APProvel~expiyei 05-31-98
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<br />;NOTE: Reed iMWCtlOrls bstors eompletinp this lorm.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !! Grd OnlYl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46531 154-611 /3Bd51 H6531 !51-611 EX TYPE
<br />I3I-37/ ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA
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<br />IMUM UNITS rs~-esl !µ5g/ /59-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I OERTI
<br />AM FA FY UNDER PENMTY OF
<br />MILIMI VATN THE INFO UW THAT I NAVE PERSONALLY ExAMIN W AND
<br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br />
<br />FiiclTard fr,llls MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP
<br />OeTNNING THE INFORMATION, 19ELEVE THE SUBMITTED INFORMATON IS
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<br />vt TRUE, ACCURATE AND COMRETE. I MI AWARE THAT THERE I1RE
<br />51GNIRCANT PENALTIES FOR SUBMITTING FALSE NIFORMAiION
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 MID ]] _
<br />SIGNATURE OF PRINCIPAL EXECUTIVE / JF.
<br /> U.S.C. f t ]1 e. lP,rWl„ udr eww rYM„ rr.,Y 1xpd, hw, W ro S IO,OW AREA
<br />TYPED OR PRINTED ra rmMmun,nAnonunt of Arrwwn errmrh, rW eYw,.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence ell sttschmsnts here!
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<br />Epp Form 3320-1 108-96) Previous editions mey ba used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ~ ~, , , +,I „ n, - ~ ~ ~- PAGE , OF
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