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PERMITTEE NAME/ADDRESS?ivLi frY~ryNar/farnm l/D.pmm)
<br />NAME ;. - .. ..- ... __ .._ .-- .'
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT lOMR)
<br />7-161 117-191
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO OAY
<br />FROM ~ ~ ~ :, _ TO '" !' ^ ~' _
<br />!14711 122-731 114151 126-771 118-791 lJ4311
<br />Form Approved.
<br />- . -. r ~ . • -. ,• .,OMB~Nm 2040-0OOA • ••
<br />~ . T' ~ APProvel exPirpe 05-31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46531 154-511 !36451 l4B53 /5667/ EX DF E
<br />137-371 MALVSIS TYP
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !a7-s31 !56561 169-701
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<br />NAME/fITLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EAMIINEO MD TELEPHONE DATE
<br /> AM FA MILIM WITH THE INFO RMATION SIBMITTED NERDN; MD BASED ON
<br /> MY INOUIRV OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS /
<br />M1~ChurU IvIIII~ TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />
<br />~nvl ronr enta i L ienogor SIGNIFICANT PENN.TIES FOR SUBMITTING FAl4E INFORMATION, INCLUDING
<br />THE PoSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. ! 1001 MD 33
<br />gIONATURE OF PIIINCIPAL EXECUTIVE (97~ G7~-2712 5 ZS n[{
<br /> U.S.C. ! 1310. latilar .w.0.r eTrsr .bNhr mry 4rp.W NrwAW ro ! 10,000 AREA
<br />TYPED OR PRINTED .nsnma.hw.niroisn+ti+re/btrwn SmwiNirid6YAVA/ OFFICER OR AUTNORIIED AGENT CODE NUMBER YEAR MO DAY
<br />GDMMCrv 1, AND t:Ar'LgrvgllVrv VC grvT VIVLq IIVIVJ IRge/BOCe en BRlCnmen [S ne/e/
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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 ,t ^ T ~ r_ ~ ~ ~ n ,1 r, ~ _ = ~ ~ ~ PAGE ., OF
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