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PERMITTEE NAME/ADDRESS (/M~b FsWry Naw/L«•r/•• t/DrQimQ
<br />NAME C'(u:. v ~. 'r' 1.[.''Y -~ +I. C??P.
<br />ADDRESS M L ' ~.. ~- ~ ? i ~i `;1: T 4 • .~ .°. . ~. ,1 ~1 'r n f,
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTMT DISCHMDE ELIMINATION SYSTEM lNPDfSI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />!7-161 17-191
<br />_ PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM Y'+ '.. TO "~ - :.
<br />170.711 l1Z-731 174751 176771 178-791 !3431/
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<br />Form Approved.
<br />T nOMB.No~ 2040-0004 :.
<br />Approvay sxpirpa.05.31-98
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<br />f NOTE: Raed Inetructlau belor l(, ao~mpletinp thb form.
<br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !~ Grd OnlYl QUANTITY OR CONCENTRATION NO FREOUEMCY SAMPLE
<br /> !4653/ 154-611 13Ba51 !46531 151-611 cF
<br />l37-371 EX
<br />µ"V515 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lFts]1 164-581 !54701
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
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<br />EPA Form 3320.1 108-951 •Prevloue sdlDOna maV be used. IREPLACE6 EPA FORM T40 WNICH MAV NOT BE USED.1 n ~ ~,) -, / n t ,,,. r T _ T n l „ PAGE 1 OF
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