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PERMITTEE NAME/ SS pers. FrrlrryNsWLoc,nw UD,dn.0
<br />NAME Ly:L'~ .'.1n!. :^r'.:.I'i,','! L„
<br />ADDRESS l: ~: ~ ~ _ ,' Y .. j ', ,
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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTM 'HMOE ELIMINATION SYSTEM NPDESI
<br />DISCHAR ITORINO REPORT
<br />1-1 I7-191
<br />PERMIT NUMBER DISCNMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM l:i_ U1 1)1] TO _ 9.9 Uhl In
<br />!1011/ 171-131 11I-151 !16171 11B-191 130-31/
<br />' Form A ed.
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<br />'Approve ree OS=31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !~ Grd On/yl QUANTITY OR CONCENTRATION NO fREOUENCY SAMPLE
<br /> !/6531 !5461 (38-451 !4653/ 154-6// of
<br />!31.371 EX MALVSS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS a1 '
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<br />!s1- 154691 /6
<br />9-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />M1 FAMILIM WITH THE INFO LAW THAT I HAVE PERSONALLY EXAMINED MD
<br />RMATION SUBMITTED NEREIN; MD BASED ON '' TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIWDUAL9 IMMEDIATELY RESPONSIBLE FOR 1
<br /> OBTNNING THE INF011MATION, I eFl1EVE THE SUBMITTED INF011MATON IS' ,
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<br />~ TRUE, ACCUMTE MD COMRETE. 1 AM AWARE THAT THERE ME
<br />SIGNIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />EPA Form 3320.1 108-961 Previous editions mey ba used. (REPLACES EPA FORM T-0O WHICH MAY NOT BE USED.) 11 ~ ~ PAGE OF
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