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<br />)CATION
<br />ATT N_t GAYIO Ll?NG ?1TNF 5[1PT.
<br />M ATIOMIIL POLLU TA MT DIICN ARG[ [LIMINATION [Y[TCM /NPDfSI
<br />D ISCNARGE MONITORING REPORT /DMRI
<br />116 1~
<br />PCRMIT NUM I[R RI.cNAwo[nuM.[w
<br />MONITORING PERIOD
<br />YEAR MO OAY YEAR MO DAY
<br />FROM n Q O TO C /l
<br />(1a~11/ !11.13/ !1415/ /16- l 118-S91 / l
<br />!1 I N G h Form Approved.
<br />(S IJ B R N J QMB ND.lP44o-0004.
<br />I- i N I T Agploval expires 6-30-91.
<br />SPOILS :;PRING ql TROUT CAEEii
<br />acc tiG Di SCHASGE II ~t (1;:
<br />NOTE: Read instructions hafore'cornplatinq this Corm.
<br /> () Card Only) GU ANTITY OR LOADING (1 Card Only) OU ALITY OR CONCENTRATION Fw EOUENCr
<br />BAMPLE
<br />PARAMETER (~6-.73) (1161) (lEa1) (1611) (11.61) NO. OF TYPE
<br />(!1-)7) ElE AMwLrBls
<br /> AVERAGE MAXIMUM UNITE -MINIMUM AVERAGE MAXIMUM UNITE
<br />616))
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<br />16910)
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<br />IAME/TITLE PRINCIPAL Ex ECUTIVE OFFICER I CEwDFr UNDER PENALTr OF uw TNAT I NAVE PERSONALLY [[AMw[U
<br />AND AM EANILIAfl MTN THE INFORMATION SUBMITTED NCREIN AND BABCD TFL[PNONE D A T E
<br />_\
<br />D-`~ LO~JC~ ON Nr INOl11Rr OF TNO•E INpVIWALS INNEpATCLr RESPONSIBLE FOR
<br />OBTIINING THE INFORMIITIOY. 1 BELI[VF TNC SUBMITTED IryFORNATION
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<br /> IS TRUE ACCUPATE AHD CWPIETE 1 AM AMAR[ THAT THCRE A/IE SIG G
<br />I~
<br />nl~~~ SU1~\
<br />1-\ NIFICANT PENALTIES FOR SUBMITTING FALSC INFORMATION INCLUdNG
<br />THE POSSIBaITY OF FINC AND IMPPISONNCM S[[ IB USC f IODI AND
<br />
<br />Isv I
<br />D uSC 11]19 Ilin.lnr• uld.r IArI+ rt.n1o n nr(dr /inr ua r.. ll4rrn
<br />SIGNATURE OF PRINCI L E%ECUTIVE ~l ~ ll~ [~
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<br />TYPED OR PRINTED .,d I,Fm.alml.nl lmon.•.nnl.Ill.I/Mlu..nAm.InlA. and .S .Nr•I OFFICER OR AUTMOR12E0 AGENT A A NUMBER YEAR MO OAY
<br />DMMFNT AND EXPLANATION OF ANY VIOLATIONS Inrlrrrn[e all allul'nmenN nrrr)
<br />MINTER •t10NIT0AING ExEI".PTE wHF.N ACCESS '1AY dE HAZARDOUS TO OPEAATUnS; ATTACii :iTATE°:iT ., DCCUMENT;.TIOti.
<br />QiifhLY Sk[1PLIN'J IYSTRCCTION.i-I.C.S, PG XIII.
<br />rA;rorm 3320.1 (Rev. 9-88) Prevloua editions maybe used. IR[PLAC[S EPA FORM T-Ie wNIDN Mwv Nor BE ueeD.l PwcE of
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