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PERMITTEE NAMEIADDREBS NMidr FxWryNa/Loc.rrm I/D~i.nq
<br />NAME ._ ..- .. .. - .. _. _ _ .
<br />(ADDRESS' ~ v ` = ~ • ~ 5 1 .. ) ~ . ~. • . ~ . . . . r- ,
<br />.. ~:LEY.^,~~1 .. jCJ °C'LJ~
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLIRANT DISCNMOE ELIMINATON SYSTEM /NPOE$1
<br />DISCHARGE MONITORING REPORT IDMRI
<br />!7- l el 17-19I
<br />b'~'1'1 '!~~ ^rL 1
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM - 7 TO " ` ' ~
<br />!767/1 111-731 !74751 !7677/ l7B-791 136311
<br />Form Approved.
<br />. • .. - - - - ,ONIB Nom 2040-0004 ~ .~
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<br />I r~ -.: - , ; } PP d exP,ii°s OS-31-98
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<br />NOTE: Rasd Mutruetiwu bafws compHtMp this 1wm.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION t,10 FREOUENCr SAMPLE
<br /> 146531 15461 138-451 !4653 154611
<br />E% of
<br />TYPE
<br />137-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167.69! MALrsls
<br />1ey581 189-701
<br />iii SAMPLE
<br />MEASUREM
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I cERnFr UNDER PENALT- DF
<br />AM FAMILIM WITH THE INFO uW rHAr I NAVE PERSONULV ExAMINEO MD
<br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br />tt
<br />P.ichzrd IJllii-`~+ MY INOUIIIY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />06TNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS
<br />D COMPL
<br />WME THAT THE
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<br />TIES FOR SUBMITTING FALSE INFORMATON
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<br />SIONIFICMT PENIV 970~S7U-i7~! O 75 9~
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<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 1B U.S.C. F 1001 MD ]] BIONATDRE OF PIIINdPAL EXECUTIVE
<br /> U.S.C. E 1]10. lMrrtl•• ur0•r N•r mwns rrr•Y Me1rN• Aws ya ro i1O,00D AREA
<br />
<br />TYPED OR PRINTED
<br />Wnnr•he•n irrp•ISwrwrr el Mrwwr6mvrN••rM6yrA/
<br />OFFlCER OR AUTHORIZED AGENT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRa/ersnce a// sttecnments oars!
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<br />Epp Form 3320-1 108.951 Prevloue edrDOne may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ^ ,~, ~ . /, r , ~.~ _ T r ~ PAGE , OF
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