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<br />FACILITY
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<br />NATIONAL POLLUTMT DIBCHMOE ELIMINATION SrBTEM lNPDESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />!1-f 61 I17- I91
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<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
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<br />1161/1 l7Z-231 174.1 b1 !16371 /18-191 !34311
<br />Form Approved.
<br />MT NF ~ , Or7ND D T70M8)No,.)20140-OOOrpR
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERT FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY F%AMINED MD TELEPHONE DATE
<br /> AM FA MIUM WITH THE INFORMATION BVBMITTED HEREIN; MD BARED ON
<br /> MY INQUIRY OF THOSE INDINOUAL9 IMMEDIATELY RESPONSIBLE FOR
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<br />SIGNATURE OF PRINCIPAL E%ECUTIVE 97D 870-2772 2 (~ 9[I
<br /> u.S.C. E 1318. IHrWeN. uWn Mr IbNfIF mry InCAd1 rulra w ro f IO,DDO AREA
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference el/ srrechmenrs here!
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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./ ~ ,t L ~ ^ ~ ~ „ ~ I• „ ~ _ 1 n / ~ PAGE I OF
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