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PERMITTEE NAME/AppRE55 pd•m F.cm'n Ner'ladla IfD10.~vJ
<br />NAME ~ . f..... A :~ Y 1.. [ .
<br />ADDRESS C:U :.'.; ~ : it : '[ •,'
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<br />FACILITY
<br />LOCATION ~ ~ ~
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<br />NATIONAL POLLUTMT CNMOF E4MINATON SYSTEM NPDESI
<br />DIBCFWR NITORINO REPORT D 19~
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<br />PERMIT NUMBER DISCHMGE NUMBFA
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM q .) l0 ~ : TO 'I H 1 2 ll
<br />7167)! 111-731 114761 116-I71 11B-79I (343II
<br />Form A ved. '
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<br />- - ~ Approv Iree 05-31-98
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<br />PARAMETER !3 Grd Onlrl QUANTITY OR LOADING /I Grd Onlrl QUANTITY OR CONCENTRATION NO. FREGUENCY SAMPLE
<br /> (/6531 154611 f3E-151 /4653 !5467 EX OF
<br />I31-37( MILLYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ls1-esl (54581 169-701
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER ~
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<br /> MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR
<br /> OBTNNING THE INFORMATION, I BFLEVE THE SUBMITTED INFORMATON 19
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<br />SIGNIHCNVT PFNALTES FOP SUBMITTING fALSE INFORMATION
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<br />TYPED OR PRINTED W nl.:artYr:l.n icsvbomwnr we.nvwr: amanrA+rM s r.~/ OFFlC:ER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (He/erence e// sffeehmenfs here) -
<br />::h'P1'Lh'A!:Lr `;UL7ii5 i.Itti"1 APPLIES OfiLY IF <= 10-Y3F 24-HH ?RF.CIP P.V3NT SS rLAT`:":. '° ,.4I". AFf'RQ1'L:'! ••'+
<br />l ~~i:!rr '1'fi> L' .. t. f17. LTSITS I:L1.L NOT bF. APPI,IF.D rr, REPORTED 'I t: ASUPF. !1 F. V'PS--SEE l.fi.] c, ~~..:~ ry ;, •, ',~ f,I,,T I~I ~ L,
<br />EP orris 33 0=Y 108=951 Previous editions mey be used. (REPLACES EPA FORM T30 WNICH MAY NOT BE USED.1 PAGE OF
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