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<br />NATIONAL POLLUTANT OISCHMOF EIIMINATON SYeTEM /NPDES)
<br />DISCH2 R61E MONRORING REPORT OM9
<br />PERMIT NUMBER D19CHMOE NUMBER
<br />MONITO NG PERIOD
<br />YEAR 0 DAY ~~~~ YEAR MO DAV
<br />FROM J }'f0 y .~ J / .: U
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<br />0 ho. 8040,-0004
<br />11'Appi 'vet ezRiiee (3531-98
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<br />137-371 MALrsle
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNI S Ifa~eal !64661 l69-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI Fr UNDER PENALTY OF lAW THAT I HAVE PERSONALLY E%AMI
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<br />MED ON TELEPHONE DATE
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<br />MY INQUIRY OF TH09E INDINDUALS IMMEDIATELY RESPONSIB
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<br />Fichard .;AI{~S OeiAININO THE INFORMATION. I eEUEVE THE SU9MITTED INFORMA TION 19 ~ ~ ..
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<br />NUMBER
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<br />TYPED OR PRINTED ,nsnm,rhR,n iNavlr,rHnrNbM„n enlnna, A,ys r,+ral OFFICER OR A17THORRED AGENT CODE
<br />COMMENTS AND E7(YLANA fIVN VF ANY VIVLA IIVNB lHI/e/eDC1 a//aRlCn/IIIOR ne/6/
<br />Sc.i7L.tAOLc Slil(_.~ ~Irl1! aAllrtU t;~l{ 10Yr(F24H12 PICECir' ;.Y:.NT-:iLt I.A.3F F'„ IYr Fi;r: KL.1•~1-:ti<_-.i.7~. LIL
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<br />EPA Form 3320-7 108.96) Previous sditione msy bs used. IREPLACEB EPA FORM T•40 WHICH MAY NOT BE UBED.) u J [ ~ 1 / i c:1 Ji11-1311 ?AGE lOf
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