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PERMITTEE NAME/ADDRESS (I+eLd• FsWy NaWLocwrnn dD18.arr)
<br />NAME ~Yc': ., „~ .'LL'~Y _^AL ^'?70,
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHMOE ELIMINATON SYSTEM INPOf$J
<br />DISCHARGE MONITORING REPORT IDMR)
<br />17-161 /17•/91
<br />"'~0^?715'1 ^7'- F
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM `f i TO
<br />110-Ill 177-731 !14751 !16.171 l78-191 /36311
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<br />Fonn ADProved.
<br />OMB-Np: 2040-0004.-
<br />Approvel expires 05-31-98
<br />NOTE: Read Inetrucrione balors completing this lorm.
<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING l4 Grd Only) QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE
<br /> (d6-531 /50-611 136-451 106-531 546/1 DF
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163-sJl !64691 !6¢701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EAAMINED MID
<br />/A1 FAMILIM MATH 7HE INFORMATION SUBMITTED HEREIN; AND BASED ON _ , - ~
<br />- / TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~
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<br />OBTAINING THE INFORMATION, I BEDEVE THE SUBMITTED INFORMATION IS ~
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<br />THE POSSIBILITY OF RME AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND J7
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<br />EPA Form 3320-T 108-96) Previous editions mey be used. (REPLACES EPA FORM T-40 WHICX MAY NOT BE USED.1
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