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<br /> Facility Name/LaraOpn•1/d10. I NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NFDES) Form Approwd
<br /> Qen 1)� ty4i! //fie DISCHARGE MONITORING REPORT(OMR) D�NO,'}�1pQ(pa
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<br /> (3 Card Only) QUANTITY NOR LOADING (4 Card Only) I QUALITY OR CONCENTRATION 3 --
<br /> PARAMETERI (46-53) (5161) (38-45) (e6-T3) I (T161) .`. C NO. FRE OF NCY SAMPLE
<br /> • (TI-37)1 I , EX ANAL VBIs TYPE
<br /> A AVERAGE MXIMUM UNITS MINIMUM 'AVERAGE. MAXIMUM :u' UNITS '
<br /> ' 6163) (6468) (69-70)
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<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW }MAT I HAVE PERSONALLY EXAMINEo'9 s a< [ ; rc - TELEPHONE _ VD A T E
<br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASEDy
<br /> / J ON MY INQUIRY OF THOSE INDVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br /> f 1'� �`/1 //•` / F OBTAINING THE INFORMATION. 1 BELIEVE THE SUBMITTED INFORMATION
<br /> C r / 5 TRUE ACCURATE AND COMPLETE .1 AM AWARE THAT THERE ARE SIG
<br /> l ,r NIFICAM PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDNG ) '_l •�-' x ' f' I
<br /> L :' .r-C �- �� �• THE POSSSC OILITY IOF FINE
<br /> rE AND. MPRIISONMENTma,EEnrl8 USC 1 1001 AND
<br /> ISIdNATURE OF PItI 46W:, E%ECUTIVE,y[/^ z,,-/233
<br /> i TYPED R jRINTED and••.maximum impnPnnmvr;r,l/hrruwn6munfh.And.l„Ir.f OFFICER.O RTAUTHORIiED AGENT . NUMBER YEAR MO DAY
<br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all mmchmenlT here) r v - �" I -: v T_' ,-g
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<br /> EDITION
<br /> EPA.Form 3320.1 (Rer. 10.79)unri� US
<br /> EXHAUSTEDD (RIPLACO [PA FORM �O WHICH MAY NOT BE USED.) VC) l- GE OP
<br /> 1 /"�'i( j£ 'I—��� L
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