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PERMfr?EE NAME/ADDRESS lrndrL FxdrryNawJlaanm yDd<..n,9
<br />NAME C Y p r i t r •. ,. ,: r .. •- ... f _- ,- ~ L .- ., T D
<br />ADDREBB Mi v:.S :, ~~.j <(t," , i rCKMAti ,
<br />FAaLm
<br />LOCATION
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM (NPDE$)
<br />DISCHARGE MONITORING REPORT (0µR1
<br />11-161 l17-191
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<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i ,1 TO "'~ n , ~
<br />!16111 /11.131 !14151 /16-171 118-191 /30.311
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<br />Form Approved.
<br />•.. r10M8tNo72040-0004 - r-
<br />Approvel nxpues OS-31.98
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<br />.` NOTE: Reed Instruetieru belal'complatinQ this Corm.
<br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING
<br />II653 15461 !s G/d Onlyl QUANTITY OR CONCENTRATION
<br />138-151 /1653 154611 NO•
<br />EX RIEGUENCY SAMPLE
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<br />!s1-sal µµV515
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<br />154551 TYPE
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<br />189-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENN.TY OF UW THAT I HAVE PERSONALLY E%AMINED MD
<br />AM FAMILIM WITH THE INFORMATON SUBMITTED HERON; MD BASED ON TELEPHONE DATE
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<br />' MY INOUIIIV OF TH05E INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BDJEVE THE SUBMITTED INFORMATION 19
<br />TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FN
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<br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAV NOT BE USED.1 PAGE OF
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