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PERMITTEE NAME/ADDRESS p,d,dr FacdlryNe•dLocs,Iw UDl~ir.nq NATIONAL POLLUTANT DISCHMOE ELIMINATON SVBTEM /NPDESI FOrtn ApprOVSd. r: <br />NAME ~ DISCHARGE MONRORING REPORT (DMRI OMB No. 204x0-0004 <br />.. ~ ,. T : . , T-rep rnasl i _ - , l ~ L L ~ , <br />ADDRESS . ~ -- . ~ Approve exp8es 05-31-98 <br />1 ~ -'r '~ f <br />` PERMIT NUMBER DISCHARGE~NUMBEP ,_ _ : ~ i <br />FACILITY <br />LOCATION- <br />MONITORING PERIOD <br />- ~~ VEAR MO DAY YEAR MO DAY <br />.. - FROM TO ,,. ,. ... .. . <br />!24271 l12-231 IT4T51 116-271 118-T 91 !3431/ NOTE: Raad Irntructiorn 6e1 a c4mplatiny this form. <br /> l3 Grd Onlyl QUANTITY OR LOADING 14 Grd OnlY1 QUANTITY OR CONCENTRATION NO. FREOVENCY SAMPLE <br />PARAMETER 106-531 l5L611 138151 ld6-531 154-611 <br />EX OF <br />l31-371 ANµYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS r6T-s9l !5}681 I6R701 <br />_ I SAMPLE ~. • • , <br />`- r MEASUREMENT <br />J _ - PERMIT ...r .: 'tT ~r'T L.i ~~....w r!<:.. ~ I~i;^.1 .'i i~. C.i.,aL .r!-t.~ <br />I REQUIREMENT / <br />, , :,T <br />~,,, <br />N , . , , <br />. ,~ <br /> SAMPLE ... .. .. .. <br />...L _ ~. r ~ -~ <br />_ <br />. MEASUREMENT <br />, <br />_ <br />.. <br />. PERMIT 1<• ':t ti•r,••r ~?tip v . e< i;[_I :.i-.. .r f j.: iYHL +ti~i~ 'K U; <br />.. <br />- <br />, REQUIREMENT - : ~ ~'~ ~i <br />L .~ ;.; r r r . <br />"~ p <br />! ,. , . <br />T SAMPLE ... . ,.. ~. , : 5• <br />_. r . _ . <br />I <br />_, I <br />• - . ~ <br />i ~ MEASUREMENT <br />_ <br />" <br />. <br />.. .. ~. PERMIT ... r ..:I •~: ?~... T <br />~ Mta.: :'7 tir•. =tip HAY: .~.r .. .- <br />_ ~~>T,. <br />.. , i REQUIREMENT _: ~ . <- ._, ti V .. p ~. rr <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PER50NAllY E%AMINED AND <br />IAR WITH THE INFORMATION SVBMITTED HEREIN; AND BASED ON <br />AM FAMI TELEPHONE DATE <br /> L <br />MY INOUIgV OF THOSE INDIVIDUALS IMMFDIATELV RESPONABLE FOR , <br /> OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS ' <br />_ <br />"' iI;J YID ~'1IIx TRUE, ACCUMTE AND COMRETE. I AM AWARE THAT THERE NiE <br />TTING FALSE INFORMATION <br />INCLUDING <br />BM <br />T <br />r' <br />~ , <br />SIGNIFICANT PENAl <br />lES FOR SU <br />I ~7O r ri'-,.7~ Z 26 9i <br />-,,r ~iir-. t!r <br />. I Y' ~' ::' Ca. ~ Z :'. I . ~. <br />.: ~ THE Pp551BIL1TY OF HME AND IMP11150NMEMT. SEE IB U.S.C.11001 AND 33 <br />510NATURE OF PRINCIPAL EXECUTNE <br />~" ' • <br /> <br />TYPED OR PRINTED U.S.C. ! 1318. lPxWdri urbr N~a renvn~ mrr IncAd~ f a w ro S 10,000 <br />uq ormum.n inpisrnw,r orbnvwndmanNS rM 6Y~ra.l <br />OFFICER OR AUTNORRED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLA I lun, lRSterence en artscnmenrs nerel <br />-. ..,~n._' ... _.-.._ -. <br />EPA Form 3320.1 108.951 Previous editions mey be uaed. /REPLACES EPA FORM Td0 WHICH MAV NOT BE USED.1 PAGE OF <br />. .. i .-. .: ~._ l <br />