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PERMITTEE NAML`~SS ldd~b f.cWryNor/7uanm I/D,p rav)
<br />NAME (,:/ i.~. f' 1, (` ~ ~~ \
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<br />ADDRESS (=:; L:). Y U i; I ;. r.
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<br />FACILITY
<br />LOGTION
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<br />NATIONN POLLUTAA NAROE ELIMINATION 6YSTEM INPOESI
<br />DISCHAR ITORING REPORT IOMRI
<br />17-18 77-791
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<br />PERMIT~NUMBER DISCHANOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM 9'S 1.0 ()1 TO ~ R ~L 7 31
<br />!76171 172-731 !24/51 176271 l78-191 !36311
<br />Form Ap ed.
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER ~ FTAMIUM VNT11NiNE INFO IIMATIONTSUBMIVTTED HERONVAND eI~EOµa7Di TELEPHONE DATE
<br /> MY INQUIRY OF TN09E INDIVIDUKS IMMEQIATf1V RESPONABLE FOR
<br /> OBTNNING THE INFORMATON, I eEUEVE THE SUBMITTED INFOIIMATIOM IS /7q
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<br />TRUE. ACCUMTE AND COMPLETE. 1 AM AWME THAT TNERE AAE`
<br />INCLUDING
<br />GNIFICANT PENALTIES FOR SUBMITTING fALSE INFORMATION
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<br />_ 1I j .~ (- THE PoSSIBIUTY Of NNE AND IMPNSONMENT. SEE IB U.S.C. 1 t0pt AND J] BIONATURE OF PRINGPAL EXECUTIVE ' ~ ~
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRs/erence all ettechmsnls hare!
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