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PERMITTEE NAME/ADDRESS pMi4F+nIq NaWLoc+non UD~G.w) <br />NAME TA 6r?i'S .. ?'. ..• -~ <br />ADDRESS T H 6 f k .: y i' <br />P+r)• . ~.l ~ 7 <br />Cr,Ai~.~ ,::J t+~o26 <br />FACILITY <br />LocAnoN <br />.+T~:~ 11. VQ;: li.l .`~ k i.; f `.., t'1{t. ~.i/GI: I+ nGR <br />NATIONAL POLLUTµT dSLHAROE ELIMINATON SYSFEM /Il~~fsl <br />DISCHARGE MONITORING REPORT /OMRI <br />!1-l61 17-191 <br />C^•U9!?11S Clu A <br />PERMIT NUMBER DISCNAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO 1 - .. <br />/3431/ l13-331 I1i351 !16371 !IB-191 /34311 <br />FCNC TC FAA <br />(S7Fp t~V) <br />F - FIDAL <br />"INCF <br />Form Approved. <br />Approvalla>~rp405- YI-58 <br />V <br />ixh NC CIECtIAR~c ~~ ~'='~° <br />NOTE: R99d M9truetlarr 69for9 compl9tlnq thM form. <br />PARAMETER 13 Grd Onryl QUANTITY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br />133 <br />37 (s6631 !646(1 !3B-/51 1653) 15F611 of <br />- <br />) EX <br />ANALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS le3dJl /69-6g1 /6&701 <br />1'~ SAMPLE ^:,`•#dr r,:# fia<r}### <br /> MEASUREMENT <br /> <br />U li4U0 1 J 0 ~FERMIT~~:': :,~ #=641CI;a.G :'A ~##~IC~Ipt>x ~ #tr4 6~~y ~ ~ a.IC lc 4~~# Q~~..~ ~ ~~ p,$r Lr l!iS IlI. <br />tt'rLU6h'T GE:JSS VALU REQUIHEME:fy7.; :;.: ,. :': ": ,`. a~a## ttj:^ML at7 :!!AX]t!U!S 5U <br />_,OLIUS, :i~TTLE.41'L6' <br />' SAMPLE #Z4#R #YI#O#ir <br />~ #>O>/trtr0 ( 25) <br /> MEASUREMENT . <br /> <br />L U h 4 5 1 0 0 PERMIT. T<~.::` % '.:::;: jC!i71:- <br /> <br />- ' <br /> <br />~ ~A~. ~. <br />P _ <br />C <br /> <br />:.. ..::. <br />~e5 <br />NCt:/ <br />~RAd <br />~FfLUENT GRUS$ VALp REQUIREMENT . `. #q#p ~CC <br />A ~~G <br />.:.CA .X.g A<Y <br />!IL/L ^1Oti R <br />l: bhE:A,, SAMPLE <:t:#01#:X #3': tra##aa to#=?# ( 19) . <br /> MEASUREMENT /~ <br />~/~ ~~. ,- <br />u~hb2 1 0 CI PERMIT <br />~ ~ <br />'~.:`4rsM '.l#O#YSa: .tr: ~ #$trtr## ##a9 # lU - ONTIX ;RAn <br />ot't"LUENT t,R~55 vALUl aEnuiREMENT <br />Li • CON., J.'!' f.: I? SAMPLE ( r,3) t1 .n 4':7S :•^, Y'C':'.' it=~%:}:: <br />i .1 ~t: Tk:tATnrI.T i tA] MEASUREMENT <br /> <br />~iJ ~J `+U i U U PERMIT k4: F%.O IiT RE?UAT oca# <br />~ Aa>S A~#n oaa#~a# c"EhI.Y INiTA! <br />.-P;'LUcNT VP,^~$ VA i. i)' .REQUIREMENT 3')D:4.AVG DAILY.ri~% RGD ~.:..x <br />~:~~' ~ ::LY1:~# <br />:.IV Li DS, DOTAL SAMPLE 0+=04:~+: •'.::Y=O#ir ;: C>Aatra ( I9) <br />~I:i~OLYEi/ MEASUREMENT <br />lU.:'i5 1 U .J PERMIT '~1.IFk+-%:+ '~#~c4#sY 4#fi 4+4L/Q:O~ C.FRxC.11.AL ~ .RL`.F4R.T TRLY ~tiAN <br />_FFLUENT GRO55 VkLq REQUIREMENT Q#tr4 BSI!:: AYG -CA~.1r N~ MG/L : <br />l N V t Sr' SAMPLE ~'~~#'~#~ ( 9U) C':AQEa tra+e>r ;r :` <br />'1 T: !-', is ; <br />VISUAL MEASUREMENT <br />-4;ISG L U •i PERMIT. D;.t.°•r;,}# REPORT ES=1 ~##as#~ oaaa#::: ~ #a'#~°~+ ~ :+.t:/~: <br />r~rELr <br />T3UA <br />:.rf'iUENT C3~~S; V'ALII REQUIREMENT INJT !!AS RC=O #'~~::# <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ ~ ~ : <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF UW THAT 1 HAVE PERSONALLY E%AMINED µD <br />MIUM WITH THE INFORMATION SUBMITTED HEREIN <br />µD EASED OH TELEPHONE DATE <br /> ; <br />MY INOUIflY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE fOfl <br /> <br /> <br />W. Gordon Patera <br />OBTAINING THE INFORMATION, 1 9EUEVE THE SUBMITTED INFORMATION IS <br />TRUE. ACCUMTE AND COMRETE. I AM AWME THAT THERE A11E ~~~ <br /> <br />Prosldent S General Manager AGNIFICµT PENALTIES FOR SVEMITTINO FALSE INP011MATION, INCLUDING <br />THE POSgEIUTY OF RNE AHO IMPRISONMENT. SEE 19 U.S.C. ! 1001 µD 9] 970-824-4401 98 20 23 <br /> <br />U <br />S <br />S 1 J19 <br />C <br />IP <br />WW <br />M <br />AA <br />p <br />f f10NATlN1E OF P111NCRAL E%ECUTNE <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />+r <br />1 M <br />+I eFw +YNw+ m.Y MIC <br />+ <br />M+ {V ro <br />/0,000 <br />.nd>muwwnrhp~iaMwlrWMrwAM emmdu rFde WA'+.l <br />OFi1CER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />t:Vmmcn I a nnv cnrcnnn nvn yr nn r Ywcn ~ was In~r"rmc9 ri mecnmems nerq <br />:c.TILx'n~:.c :30L.IUS LI':: l;Ai bf,' k7AIVEG F.)3 >l0t',2uf!F PdECIp QVF!IT• - `EF .4 LT0_FNA7 LI.':ITATIONS UND°` <br />l.f.•l.;i, ANG AL:,O 3UH~7c:!i OF pR00F_flE^lUIFtE?1E:iTS UlIDER i. A.J. CII f GEFASR' - SF2 I.B.1.(L). TD_i <br />EPA Fam 3320.1 108-951 Praviou9 editions may bs ueed. ' (REPLACES PA FORM •30 WHICH MAY NOT BE U D.1 p 01 3 C / 9 7 ] ~ 11-1 b 4 b PAGE lOF / <br />