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<br />PERMITTEE NAME/ADDRESS pnrir6 FmrGryNa/Locana dDldrar)
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<br />NATIONN POLLUTMT OISDHMOE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMRI
<br />!7-/81 l17-l91
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<br />PERMIT NUMBER OISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM "'I L TO Y 1, '.
<br />116111 l1Z-131 !14151 116.771 l18-191 136311
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<br />Form Approved.
<br />T.TOMB-No~20.40-0004 ;~
<br />Approval a%piree OS-31-98
<br />NOTE: Reed Inetrueliorr before ompletinp this form.
<br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING !~ Grd OnlYl QUANTITY OR CONCENTRATION ND FflEDUENCY SAMPLE
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<br />NAME/TETLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDEII PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />MILIM WITH THE INFORMATION BUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
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<br />~l MY INQUIRY OF THOSE INDIVIOUK9 IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB -~ ~
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<br />eIGNIFICMT PENAITIEe FOR SUBMITTING FALSE INFORMATION
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Reference a!/ sttechments here)
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