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PERMITTEE NAME/ADDRESSN~d. frrbry N~/Locrron l/DrfmrwQ <br />NAME ItiAYPF" >~='T+~.;~ I'. .:. <br />ADDRESS T R A P E' F' ~ ~ h ~. `~ <br />P.O, b ;,( i <br />cF:AI~ ro rlJ;z <br />FACUm <br />LOCATION <br />~T.T.h: rl• GOtitl..rh E~C.:.Fi. P3F.S/ut. ~ %i{ <br />NATIONLLPpµ~TANt (MSCNAAGE ELIMINATION SYSTQA (NPDFSI <br />DISCHARGE MONITORING REPORT (OMRI <br />/2-761 17-19/~ <br />~UOD32115 (tC A <br />PERMIT NUMBER DISCHARGE NUMBFA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO I '. _ <br />126111 121-231 /I<-161 !16171 (18-291 J363/1 <br />Form Approved. <br />C A K A i ? C ? L K G U L~M~ Na. 2040-0004 <br />{ , U ~ R t: il) APProvelle~p~rP 05-31-98 <br />F - FZD.i1 <br />t"INCF, <br />ry''0 NC %ZSCHpRCF. IY~ %r'"~ <br />NOTE: Reed Metructlarr befor completlnp this form. <br />PARAMETER l3 GFd Onlyl QUANTITY OR LOADING !1 Gfd Onyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> !1653 /50.611 (38.151 (<6-53 (50.61) OF <br />(32-371 EX <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS .MINIMUM AVERAGE MAXIMUM UNITS (62-e~1 /61.561 l6a7Dl <br />-~!~ N .A~i: SAMPLE At4$S~n: ( 9t1) #Et't'>'L %AARR:4 dL,<~`## <br />J I B I1 A L MEASUREMENT <br /> <br />4i/E10 1 0 D ,:PERMIT ~:. ~-d =s# ~..K B:p~~'C.~ ES=1 "#~A~R111~+n #a:~Q~aS:'Jr ~.~~lr t't##16. i#~: :~ .i•; r;xLY YF51)pt <br />.:'F'LUENT GflOSS PALO ..REnl4iREMENT -INS%' lldt':. YC=U #~+. ~ " <br /> "SAMPLE <br />' MEASUREMENT ~" <br /> ?ERnAt7 <br />" <br />: ... . <br /> .. <br />. <br />~ ':: <br /> <br />~REQUTAEMEKT~~: r..... <br />: ~~ <br />...: ~. <br />.. . <br /> SAMPLE <br /> MEASUREMENT i) <br />~// <br />~- <br /> ~- PERMIT ~ ~ ~ ~' ~ ~ <br />- ~ <br /> REQUIREMENT " <br /> SAtvIPLE <br /> MEASUREMENT <br /> '::•:. PERMIT .! :.j". . <br /> '~iEQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,.~ .. .. .. .~ <br />... .. <br /> .REQUIREMENT~ :~.': ~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERM17" <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> : PERMIT ~ ~ ~ ~ ~ ~. <br /> ~REQUIRENIENT. " <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I cERD <br />AM FA Fr uBOER PENAITr DF LAw TNAr I NAVE PERSONAUY E%M11NED AHD <br />MILIAR WITH THE INFORMATION SUBMITTED HEIIEIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br /> <br />W. Gozdon Petrrs OBTNNING THE INFORMATION, I OEUEVE THE SUBMITTED INFORMATION IS <br />TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE ~ ! n I~~ <br />p.- C f <br /> SIGNIFICANT PENALTIES fOR SUBMITTING FALSE INFORMATION <br />INCLUDING 910-824-4401 98 1D 23 <br />ProBldent b Ganaral Manes •r , <br />THE POSSIBILITY OF RNE AHO IMPRISONMENT <br />S.C <br />SEE 18 U <br />1 1001 AND 37 <br /> . <br />. <br />. <br />~ eIONATUIIE OF PRINCWAI E%ECUTR/E <br /> ~ ~ ro f Io,o00 <br />' <br />w o ~ <br />xY <br />in ~ "' <br />ei <br />:N <br />` <br />~~ <br />a <br />~~ <br />TYPED OR PRINTED ,,, <br />n.F <br />r <br />r <br />y <br />n, <br />„ <br />n <br />a <br />ywa/ OFFlCER OR AUTHORIZED AOEM CODE NUMBER YEAR MO DAY <br />wmmrn I a nnv enrlwnn I rarn yr nm vlvLn I Iona Inemmq ai m~cnmenrs npq <br />i5S E YUIP.L Ir^r.' LICITr; WILL F]E uAlYE7, A9G :;:-TTLEAi!LF, SJLIC_ III']? ~FfIIFC FCF <.=lOYR,a';R ~nCZP FYi:FT- <br />_EE bUKUEU OF PROOF' FElUIi:EMEH'SS s1yDg? I.A.3. TDS MOtiITORING - I.F.?. t)SL E CFCASF. - S8 I.F>.1.(D). <br />-_ r• -- <br />EPA Fwm 3320-1 108.951 Previous editions meY be used. IREPLACEB A FOR 40 WHIC MAY NO B USED.) 0 0 C 2 9 / 9 7 ] 211-16u Er PAGE ~OF ~ <br />