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PERMITTEE NAME/ADDRESS R.~LFrurryNwN/Locrtlw dD,p..P.p <br />NAME .. _ .. ~ ' <br />ADDRESS -~~ i <br />.. ~ _ " ~ / / <br />FACILITY <br />LOCATION , .- ., .. "' i i) J <br />. ., i _ ~ ,. <br />NATIONAL POLLUTANT DISCHAIIDE El1MINATION SYSTEM /NPDESI Form APProved. <br />DISCHARGE MONITORING REPOIIT (DMR) <br />r1-f sl 177-I9 i' l y ~ % /'"; T ~+ '~~ ~ \OE~BINo^l.o4Q•0004 <br />9 ', 1! '" 1 / ~ ~ ;- t (c ; • .1 , ~ I Approvet e~~ifpe 05-31-98 <br />PERMIT NUMBER DISCHARGE NUMBER _ <br />MONITORING VERIOD <br />YEAR MO DAY YEAR MO DAY - - ,~, <br />FROM ~ ~ TO . 1 ~ - ~ ~. i 'r ~' ~` <br />nn~ll v~a.Ti v4~sl ns-nl Izsasi /3n3u NOTE: Raed Inetructiorr 6efon compbdnp thb form. <br />PARAMETER l3 Grd Onlvl QUANTITY OR LOADING 11 Gld On/Yl QUANTITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> Hs-531 !5467 !39<51 1Q6-531 154611 <br />EX OF <br />TYPE <br />l3Z-371 ANALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-s]1 164-sel 169-701 <br /> SAMPLE ~ ~ - - - ~ ~ ~ ~ ~ - 1 ,: 1 <br /> MEASUREMENT <br />• PERMIT ... .. .- . ~ :: .. .. a . 'a . 1- Y ~ r 't <br />- REQUIREMENT "i .. i:~ui: `iA• •..1 i~ <br />.. _ . , ~ '.. SAMPLE .. .. .. .. .. ' `> ) <br /> MEASUREMENT <br />, I I : PERMIT .:7h: r: x =: .. ^•S~G-,f.,. ~~.. '} h.:~ i M': ,I .. <br />- . S i t..i ~: REQUIREMENT . ;: 3 i t Y "' li [ / L ~:) <br />.. 1.' SAMPLE - ~ - ( I ~) <br /> MEASUREMENT <br />:.. J ) PERMIT -. .- .. .- ... ... .) '. ~ ~ . . <br />.., ~ . .. - t' p, ! REQUIREMENT ;'; _ <br />I .-.)!1 ~ 1 i P SAMPLE ( ~) <br />i C ~. 7 ." Y {. MEASUREMENT <br />. I L J ~ PERMIT ~ _ , i i [. .' 7 •. <br />, ~ ~ ~ ~ ~ -• ~ ~ ~ ~ . , ' :. <br />. _ r. n ; :; R 7 i S .. REQUIREMENT I I'; # J -; Y <br />: i `.. .. <br />.. .. .; '.t '.~"' SAMPLE ( 11 <br />.. I .~ ;- MEASUREMENT <br />i ~ PERMIT .:: r ~ .... . i` ~ ... ... _ ..• . -. / <br />_ _ , .: ! : ~ :) ~ .... ~. REQUIREMENT L ; S ^ ; .i i{ )_ ~ ~ -. , . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF <br />MILIM VNTN THE INFO UW THAT I NAVE PERSONALLY E%AMINED AND <br />RMATION SUBMITTED HEREIN; AND BASED ON - TELEPHONE DATE <br /> <br /> <br />kiChard <br />S. hlUnsCln <br />MV INOUIRr OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />I BELIEVE THE SUBMITTED INFORMATION IS' <br />OBTNNING THE INFORMATION / / <br /> <br />/ // <br />. <br />ident <br />Sce Fre , <br />TgUE, ACCUMTE MID COMPLETE. I AM AWARE THAT THERE ARE <br />INCLUDING <br />SIGNIRCANi PENALilES FOR SUBMITTING FALSE INFORMATION '~! , ,~ ~-(l / ; , ~_~y;~ ~ ~_ <br />- <br />> <br />k <br />s <br />F , 5 <br />~-p ~2~ <br />721 9 <br />+ 10 Ol <br /> THE POSSIBILITY OF flNE AND IMPNSONMENT. SEE 18 U.S.C. f 1001 AND 3] BIONATURE OF PRINCIPAL EXECUTNE <br /> U.9.C. f 1]te. /PPw1tls utlr rMw Nerh. rPrY Mcpd~ fiMr .Pro 510,000 AREA <br />TYPED OR PRINTED .n/amu.nun MpitoPrrrn e/Mwwn 6mmN. nM6Ywra.1 OFFlCER OR AUTHOPI2ED AGENT CODE NUMBER YEAR MO DAY <br />,.tCOMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s// sttecnmenb here/ <br />EPA Form 3320-1 108.951 Previous editions may be used. (REPLACES EPA FORM T-0O WHICH MAY NOT BE USED.1 i , / ~ , ; - PACE OF <br />