|
PERMITTEE NAME/ADDRESS O.~L FmWryNsr/faaum pD106nw9
<br />NAME :. H.-. ~. -.•[~. _I ,
<br />ADDRESS '' : '
<br />J I , ~ 1
<br />FACILITY
<br />LOCATION ,~ ~ ., i .
<br />NATIONAL POLLUTMT DIBCHMOE ELIMINATION SYSTEM /NPDE$J
<br />DISCHARGE MONITORING REPORT (OMRJ
<br />l7- I el 17-191
<br />'a;H500?~
<br />PERMIT NUMBER DISCHMGE NUMBEI!
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 1 ~ % •_ TO . ;
<br />tl0-]fl tlJJ31 !14751 !76171 178-791 /36311
<br />Form Approved.
<br />•.~ _~ n n F / ".' ° T 9 T `: r- 4 P~BJNoS 204q-0004
<br />- ADProvel a Aires OS-31-98
<br />(;pb'N ,e~, L~
<br />- 9 ,.
<br />-:. .. .. I_r I ~:.
<br />NOTE: Raed In~tructloru belore eompletlnp thu form.
<br />PARAMETER !3 Grd OnIYI QUANTITY OR LOADING !I Grd Onlvl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> !46531 (54611 l3B-451 !4653 1546E
<br />EX OF
<br />TYPE
<br />137-371 MALrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-s.Tl !54681 169-701
<br /> SAMPLE .. , , ... / i ~ 1
<br /> MEASUREMENT
<br />- 1 PERMIT . - ~ . , . r _ ~ .: - '.r i.' . ? I.!
<br />1. ! ... - I _ REQUIREMENT .. ' ? :T ~ is ~~ ;. •'^ n'! :~ `I'.; ;' -
<br />.... , , ~ :.. .. .. SAMPLE .. ... ... .. .. { : )
<br /> MEASUREMENT
<br />.. '1 :' PERMIT ... .. .- . ~;T ::: .. .. ~. ,-, ~, :z a .).'n IV :;; P~/ ..,
<br />. .~ .. ... - .:: ~; ~ 'J , I.'i i. REQUIREMENT 3 e : t Y !' $ 't L L '!:1 :•. ; :.
<br />... ,, ~ ,.. i a C SAMPLE .. r . ( ~ :1
<br /> MEASUREMENT
<br />. .. -. ~ ~i PERMIT
<br />-
<br />.. ...
<br />.;
<br />.. ..- .. .. , ',: s Y ~ ~ .. `1 ~~ r ? 1 :, 1 ~.
<br />J :.. 2; S; `: REQUIREMENT - ~ y r , /
<br />-, , .. , ". I .: J ,. - , ~ SAMPLE ~ t ~
<br />. 7 , 9 f FI F, • '. .. MEASUREMENT
<br />. ~ ~ ~ PERMIT .:: p : 1 Y E [, -;1 P, i ... ~ ., .. . Y ~ - ! -
<br />. .. GH: REQUIREMENT sL.p~-~.: J,1 i.T '1Y "hf-. ^')y ..
<br />
<br />.
<br />.-. ~rLEr~ ~ SAMPLE •~'?'~. ( "37)
<br />..
<br />..,
<br />...
<br />..,-. -:
<br />_ , , MEASUREMENT
<br />1 :..1 PERMIT ~ .. f :, ~ LT .i' .' .- ! .. . .... - I
<br />„ , ~ REQUIREMENT j ;y <.; ; -- a ~ - 1 ~• .: '. ~, . ;
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENUTY OF
<br />AM FAMILIM WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN; MD BARED ON - TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~
<br />~
<br />~. IiUn EiOT'.
<br />'1L'f1RI'C~ OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS-
<br />T TN
<br />T ~ ~
<br />~
<br />'
<br />~
<br />'L'-- .-
<br />. HA
<br />ERE ME
<br />TRUE, ACCURATE MD COMRETE. 1 AM AWME
<br />IFICMT PENALTIES FOR SUBMITTIMO FALSE INFORMATION
<br />INCLUDING ,~~ ;^,L - ,I .`.
<br />~
<br />~
<br />. o.y
<br />- C
<br />"
<br />'
<br />'
<br />( C
<br />'
<br />tdent
<br />~Cb Yre ~ ,
<br />BION .,
<br />,(
<br />j ~~3_
<br />I %21 )
<br />;l 1G ~/].
<br />. THE POSSIBILITY OF RME MD IMPRISONMENT. BEE 18 U.S.C. ! 1001 MO ]] i BIONATURE OF PRINCIPAL EXECUTNE
<br /> U.S.C. ! tJts. fnwNl.. uMr ewr moms nlrr M,cX.W bwa w ro S Io,000 AREA
<br />TYPED OR PRINTED .rgwmuinurr tim+++av,I.eFae.lw.«,sm~n,..ss!-~1 OF1:IceR OR AOEHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />f-OMMENTS AND EXPLANATION OF ANY VIOLATIONS lRelerencs sn stteenments nsre/ ,
<br />l.. ••., . ,. .. .r - -.,, I t-1-1.
<br />'.
<br />EpA Form 3320-i 108.951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 I / .J t PAGE . OF
<br />
|