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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERTIFr uNDFR PENALTY GF uw THAT I HAVE PERSONALLr ExAMINED AND
<br />AM FAMILIAR WITH TMF INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
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<br />-. MV INOUIgY OF THOSE INDIWDUALS IMMEDIATELY RESPONSIBLE fOR
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<br />EPA Form 3320-7 108.961 nPrevioue edmone mey be used. IREPLACEB EPA FORM T30 WHICH MAY NOT BE USED.1 ^ ~„ , T / ^ T ^„ ,~ -/ _ T ., ~ „ PAGE f OF
<br />NATIDMAL POLLUTANT DISCHAliOE ELIMINATION SYSTEM (NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT lOMRI
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<br />"' T '~ F 1 0 7 u~ o r nOAQB?NolT 2040-0004.,
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<br />PERMIT NUMBER DISCHMGE NUMBFA - o r „ i -
<br />MONITORING PERIOD ~ n ,
<br />YEAR MO DAY YEAR MO DAV
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<br />FROM U 1 TO ':'l n T : a.:.,.. ._ ,., ~ ~ -..-, I _. ~. .
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<br /> NOTE: Read Inetruc Elone before complatlnp thu form. ,.~
<br />!IO-7I1 111-731 176751 1I5-77I 179-191 13ti3/1 ,
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<br />TY OR LOADING !1 Grd Ontyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br />!5451 138-e51 !46631 15I-511
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