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PERMITTEE NAME/ADDRESS OAir6i.NlryNar/l,o[slla UDrpw,.p
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<br />NATIONAL POLLVTMT DISCNMGE ELIMINATION SYSTEM lNPOE$) Form Approved.
<br />DISCHARGE MONITORING REPORT lOMRJ , . _ - _ " _ OMB,No•.2040-0004 + ~.
<br />l7-I6I I7-191 r
<br />... n ~ 7 7 2 { ,. !, (- - _ , ~ APProvel exPirae05-31-98
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<br />YEAR MO DAY YEAR MO DAV
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<br />!16711 l77-731 !74751 116-771 115-79/ 136311 NOTE: Raed Inetructlone before/eom{`atinp Ehie form.
<br />PARAMETER l3 Grd Onlvl QUANTITY OR LOADING le Grd only! QUANTITY OR CONCENTRATION NO FREDUENCr SAMPLE
<br /> Il6531 !54611 13845/ !<653 /Sb511 E OF
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<br />MALYSs TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e7-e J/ 154681 169-701
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<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENUTY OF LAW TNAT I NAVE PERSONALLY EXAMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSf INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP
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<br />Richard Id11Iis OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />[nWronMO~tal ;::r:T+aer TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />(970)870-Z7T2
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<br />THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE to U.S.C. ! 1001 MD 37 SIONATORE OF PRINCIPAL EXECUTRFE .
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