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PERMITTEE NAME/ADDRESS (I.Cilyd L NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDES) Form Approwli
<br /> Faerllry' xalne/Lrxorlon I/dlDrrrnr I �1 r DISCHARGE MONITORING REPORT(DAIR) OMB No.2O10MM
<br /> NAM! _sue _ 1 1-16 l 17.19 rt
<br /> F r F i N2 L ` APPfOPd tI, a 12-31-87
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<br /> PERMIT NUMBER ' DIBCHA ROF NUMBER p I c ^ n
<br /> MONITORING PERIOD
<br /> MO DAY YEAR MO DAY-.Ll
<br /> LOCATION --. L!—� — ,:) _ • F�OM e. 1 U U L TO 'I t l i t l MCI Ji. = - . < D (f 11•r 1:•
<br /> 1 ,JZC— r 1cI 1 (goal) (11-23) (24-25) ( 6 ) (Ia'1v) Goal) NOTE: Read Main ,llonE bslon complsllnp WE lorm.
<br /> 1 (3 Card Only) OUANTITYIOR LOADING (4 Card Only)- QUALITY OR CONCENTRATION '
<br /> PARAMETER (46-53) (3461) (36+3) _ (46-53) I (5461) ` c - NO. FREOOUI NCTFSAMPLE
<br /> k EX ANALYSIS(37J7) ) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE•, I MAXIMUM UNITS- (61fi3) (616 )) )
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<br /> NAM!/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE Y PERSONALLY ERAMIHED +"� a� _ - -TELEPHONE _ O A T E
<br /> AND AM FAMILIAP WITH THE INFORMATION SUBMITTED HEREIN. AND BUSED J J Y .. , Y. - -
<br /> J r OH My INQUIRY OF THOSE INdVIWALS IMMEDATELY R[SPONSIBLE FOR - .J-:.� 1 , `- _ ..1 N. '•]
<br /> OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION ^/-��'
<br /> IS TRUE. 'ACCURATE AND COMPLETE n AM AWARE THAT THERE ARE SIG .• ��
<br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING ' `J`�
<br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SCE IB U.SC 1 1001 /IND / 4 i �'f.
<br /> '•� / "A w'e{ /I 'rM/�'f r 33USC 11319 rP,.I,., und- rhe- Immin mey -dude N,. up m JM.A., L SIGNATURE OF'PRINCIPAL EXECUTIVE „J- 7 j1 9'a /
<br /> o.d-nanrnum ImOnurmm�H nl hrmvn A month.and i'mrm I - - - - -y '
<br /> TYPED OR PRINTED L-_6FFICER OR AUTHORIZED AGENT. 'NUMBER YEAR NO DAY
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<br /> COMMENT AND EXPLANATION-OF ANY VIOLATIONS (RFlerenre all anaehrllenu here) i 0 . _-� _^_ y I '_ S` ;: r_ " `
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<br /> EPA Form 3320.1 (KiV. 10.79)PREVIOUS UNTIL SUPPLY IB EXHAUSTED D (REPLACE:S EPA FORLI'r0 WHICH MAY NOT SE USED.1 V UU tl r/(iY(1.5!' - 3 c V I-AGE I OF
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