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PERMITTEE NAMEIADDRESS p.~m Aewry Na/Lornlar lfOQTYgI)
<br />NAME j[.;y~(;A CJAL C(lyeA::T
<br />ADDRESS D R A r Y. k U
<br />HAYUdM CO Klb3)
<br />FACILITY
<br />LOCATION ti N T ~ :_ i`
<br />Cif 81njJ
<br />h I'~L'le: :.. :,UD `.:wl+_ G:.-. r'nAl. P.itlli: i:v
<br />NATIONAL POLLUTMT DISCNMOE EUMINATON SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />1-161 17-191
<br />I O
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ 93 i]7 ?1 TO 9g ~~ 3^
<br />d111 Ill-191 tl4151 116171 118-191 !36311
<br />Fonn Approved. o
<br />nI_i: RA SGr. TJ TSiZn~Q~F ~1or2 40-000.4
<br />Applbv Ilsx~pirej'Oti^31-98
<br />(s~lAx N:I) 11345
<br />7 - f'*1.qL o
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<br />NOTE: ResA Irutructloru before LRmlpbdnp this form.
<br />PARAMETER !3 Grd On/r! QUANTITY OR L ING !4 Grd Ontyl QUANTITY OR CONCENTRATION ND, FREQUENCY SAMPLE
<br />
<br />l3I-371 146531 1545/f !3B-151 (<653/ !54611 EX KY TYPE
<br /> AVERAGE MAXIMUM ~ v+UN1T5 M AVERAGE MAXIMUM UNITS
<br />MINIM
<br />U l63-eJl 9S
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<br />MEASUREMENT tG4C,;+ ,, .. ~,. .. ... 7c4= ~ ( jgj /,
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<br />I.Si _~.: 1 0 U PERMIT S:J SR.~t ~ ;kRa44# ~ fifiYd~~:. °:.hik 141x#. ~. 1: (}.
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<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF L
<br />MILIM WITX THE INFOI AW THAT I HAVE PERSONALLY EXAMINED MD
<br />UTATON SUBMITTED HERDN
<br />MD BASED ON \ ~ TELEPHONE DATE
<br />_ ;
<br />MY I
<br />QUIRY OF TNOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR
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<br />OBTNNING THE INFORMATION, I eFLEVE THE SUBMITTED INFORMATION 19
<br />ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />TRUE
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<br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCIWING p _ _
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<br />' 1 ~ 1 ~ ~ „ '., ~ , V THE PD$SIBIUTY OF RNE MD IMPIIISONMFNT. SEE 18 U.S.C. f t00r MD 9J BIONA7URE OF PAIN AL EXECUTIVE
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<br />r U.s.C. E t 11 e. fhmler. uWn fMS mem. r~Y !'NA.d. ri1H W ro t 10,000
<br />J TYPED ON
<br />PRINTED .os ormvwrvn iMrionwnr W Mtrna emarNS rM a EvnA/ OFFlCER OR A ORQED AOENE CppE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /ReJerencs ell sttschmsnts here!
<br />IsJ Lieti A'CLL .; e: I:A1V:.U ANil Se.T7LEAr1L% SJLICS ~!rtI: APPLIED Fed <=10Y9.21HR ?3ECLP SPENT; TSS L
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<br />i40 WHICH MAY NOT BE USED.) 000 1 9/98 0 91(1-0923 PAGE 1QF
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