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<br />NAME CYPVtI" y.6.Yp1 VALT'Y "~1L CDR?.
<br />ADDRESS "I I ..°i I; :i ' ..: S I ~ O IJ ~- r . K h A ~+ i'
<br />FACILITY - -
<br />LOCATION
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<br />NATIONAL POLLUTMT DI$LHMGE ELIMINATION SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />11-161 17-791
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM "~ I TO " ! ~
<br />110.11/ 111-131 !14151 116-171 !IB-791 /36311
<br />Form Approved.
<br />•• - g^ '+ h 0 v n v - r10MB,No:12040-0004.- -,
<br />_ „ ~ ,M1 1 Approval expilpa 05-31-98
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<br />PARAMETER !3 Grd Onlyl QUANTTY OR LOADING l~ Grd Onryl QUANTITY OR CONCENTRATION ND FREOUEMLY SAMPLE
<br /> 146-531 !51.611 I3B-651 1a6-531 154611 GF
<br />I3I-37/ EX
<br />Muvsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !61.691 /64681 169-70/
<br />., SAMPLE -R G; ~--: 0:>:,'-;..: .. ( l ~)
<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER I CERTI
<br />AM FN FY UNDER PENN.TY OF LAW THAT 1 HAVE PERSONALLY E%AMINED MD
<br />AILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON ,r
<br />p TELEPHONE DATE
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<br />MY INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR r
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<br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~~
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<br />F~ICIItlYd Iv:IIIi TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME A/
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<br />' AGNIFICMT PENALTIES FOP SUBMITTING FALSE INFORMATION, INCLUDING . 07D u/D-Z]r2 ~ ~'J 93
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<br />ntiri rcnrle THE POSSIBILITY OF HNE MD IMPRISONMENT. SEE 18 U.S.C. ! 1001 MD 3J SIGNATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. ! 1 J10. (F1rlralrF NN6/ err mam6 nvY Mcll/e1 6r+ W ro F 10,000 AREA
<br />TYPED OR PRINTED r.e ar mFrinrn vry+rl6NVnarrr orbrrw,smoner 6rM 6YSVa1 OFFICER OR AUTHORIZED AOEMT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOCAI IVNS !/laerence a6 sttscnmsnts Here/ -
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<br />EPA Farm 3320.1 108-951 Prevloue edlDOn3 may ba used. IREPlACE6 EPA FORM Td0 WHICH MAY NOT BE USED.1 ~ ,1 ~ 5 ^ /„ n ~ 11 ~ 7- Z ~ j r PAGE [ OF
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