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PERMIfTfYE NAME/ADDRESS pnaYb F:WryNr'Locmla, gDtpwF,q
<br />NAME , t ~ - - - _ ~ .
<br />ADDRESS ~ L'. :. T ~ •.'. 7 iflL ~, _. _ ~ .. .. +
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<br />
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE EUMIMATION SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />(7-r51 n7-rsl
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<br />PERMIT NUMBER DISCHARGE NUMBEA
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM "1 .)~ J TO 'I'I f ti '1
<br />!]a2/1 l22-231 !24.251 /36-771 /75-19/ (3631/
<br />Form Approved.
<br />+ . r. - ...~ OME4No:•2040-0004 -
<br />^ Approval exDi[es OS-31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Grd Ontyl QUANTITY OR CONCENTRATION NO FREOUENCV SAMPLE
<br /> (d5-531 15d-611 138-151 !<5-531 !54611
<br />EX OF
<br />TYPE
<br />(37-371 ANN.YAS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVER
<br />AGE IMUM
<br />MAX UNITS !e]-ea) 15d-5sI 163701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />NI FA FY UNDER PENN.TY OF LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />MILIAR WITX THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOR
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<br />SIGNIFICANT PENALTIES FOR SUBMITTING
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<br />TNEPOSSIBILITYOFFNEANDIMINUSONMEHT.SEEIBU.S.C.It001AN09a
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<br />610NATURE OF PRINCIPAL EXECUTNE
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<br />TYPED OR PRINTED ,rvnmu:rrwnlrrpla.nwROrbMwn6mwM„n06y,ral OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRslerence a/l sttscnmenta Oere!
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<br />EPA Form 3320.7 108.95) Previous editions mey ba used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED,( PAGE OF
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