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-cRMITTEE NAMEIA~SS (1..x,6 isWryNr~laaum yD,p...,v/
<br />4AME ,
<br />ADDRESB 1, U L U n 7 1 !~, T 1~
<br />`i 7 i 1 S ". 1,'i' r N I C: I! F !.'Y 1 3
<br />ae:;;I'L!' ril 21641
<br />FACILITY
<br />LOCATION -~ ~ /
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<br />NATIONAL PoLLUTN. HAROE ELIMINATON SYSTEM NPOESI
<br />DISCHARG ITORING REPORT
<br />l1-161 17-191
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<br />PERMIT NUMBER DISCNNiGE NUMBFA
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM ~/S 17 O1 TO 'IR 12 ~l
<br />IYO-711 113-13) !16151 118171 138-29I !3631/
<br />Form A ed.
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<br />($ U ? R li'~. } -~ ~ ~ APProve 1 ee OS-31-98
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<br />••NOTE: Reed Inetrue0orw 6elora eolnpletiny This:form.
<br />PARAMETER !3 and Onlyl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION
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<br />37 !46531 !54611 l38-45I 10653 !56611 ' DF SAMPLE
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<br />AVERAGE
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<br />l 164581 !69.701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDFA PENKTY OF
<br />MILIAR WITH THE INFO UW THAT I HAVE PERSONN.LY E%AMINEO AND
<br />RMATION SUBMITTED HEREIN
<br />AND BARED ON
<br />/ TELEPHONE ~ DATE
<br /> ;
<br />Mr INQUIRY OF THOSE INDIVIDUN-S IMMEOIATELr RESPON4BLE FOR
<br />OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INF011MATION IS ~ /~L/~ ,'
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<br /> TRUE. ACCUMTE ANO COMPLETE. I AM AWNLE THAT TNERE ARE ~
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<br />~ ,.. SIGNIFICANT PENN.TIES FOR SUBMITTING FALSE INFOMIATION
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<br />THE POSSIBILITY OF RNE AND IMP/IISONMENT
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<br /> U.B.C. ! 13th, lArWrY1 u,C~ orw Niema nrY YtcAW aM. w ro J 10,000 RINCIPAL EXECUTNE
<br />TYPED OR PRINTED
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<br />EXPLANATION OF ANY VIOL r,d antuiwm i,p+Iwvnwtol Mnrwnsma+NaW 6ywra/
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<br />ATIONS R ~ OFFICER OR AUMOflIZED AGENT AREA
<br />CODE NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />~,OMMENTS AND l e/s/sncs ell attachments heJel I~
<br />!.i:l'I'Lcdi:Lr SULTi~:; S.I.`T'! ili'Pl.IF.S OtiLT IP C= 10-Y~, 7,4-!{? opcrTp FYEI:T. IS Ci..4THF*`. ?f' t:'L:T'a rui'~i7nVr'~::. ti'
<br />„I,!_l~, '!';;:; !: Ih'''". LIwTTS %%I1.L rIOT 5F: APPLIEf TO :~F:F:~iiTTU '".E R':LIR°:1!o,NTS--Src -,R,?,., i't' +; !, `li` I.".Tfr IG 11.
<br />RYA Form 33 n0=1 108-951 •Previoue editions may be•useE. ~ /REPLACES EPA FORM TAO WHICH MAY NOT BE USEO.1 PAGE '' OF
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