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PERMIT7EE NAME/ADDRESS pwrYLfsWryNaWI«auu VD7B..nrq
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<br />FACILRY i _ 1 .. r, ,=
<br />LOCATION
<br />NATIONAL POLLUTANT OISCNMOE p1MINATON SYSTEM /NPUESI
<br />DISCNARGE MONITORING REPORT fOMRI
<br />T-16 17-19
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ,) ~> ' ', ^ TO o -? ~ :, -I -.
<br />lT6T11 !TT-T 31 131-T 61 1T6T7/ !TB-T9/ I.lYY311
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<br />1' I -.:. A t .- r1 ~ _~ .. ,QM~,No'2040-flQ04
<br />' Approvet explles_ 5-31-98
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<br />NOTE: R~sr( kMWCdon bifon~d6111p~edny this lorm.
<br />PARAMETER !3 Grd Only! QUANTITY OR LOADING !/ ad Onlyl QUANTITY OR CONCENTRATION NO. FREOGENCY SAMPLE
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<br />NAME(TITLE PRINCMAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINFD AND I r TELEPHONE DATE
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<br />MY INOU111V OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR
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<br />TYPED OR PRINTED U.S.C. f t al B. fh1rlW. ur1•r Wr mnm• ,N.T E'NM,M ln.. w ro i 10,000
<br />rN Ormufnun irMrrla+%rr.rt olMnr..n emmm.rd 6l+rr<1 OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO' DAY
<br />COMMENTS AND EXPLANAI wN ut Arvr vwLA 1 was lnsrwenee of errecnmsnrs neTS!
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