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PERMfFTEE NAMEIADDRE55 p.d.d. FrrbryNw/lasnm I/DIQ ,~rl <br />NAME _ <br />i ~ . .. <br />ADDRESS - -~ <br />FACILffY <br />.i. _.. <br />LOCATION <br />- -,~- <br />- yaN. .%O ri _y <br />NATIONAL POLLUTMi DISCNMOE F1IMINATON SV~TErM IryPDE:i/ <br />DISCHARGE MONITORING REPORT IOMRI <br />2-161 17-I91 ',.~j^ `. ~~'! .' <br />PERMIT NUMBER DISCHMGE NUMBER _ <br />' ~ ~ MONITORING PERIOD - <br />YEAR MO DAY YEAR MO DAY <br />form Ap aroved. <br />r -- ., „ ~ qM~r n1.o. 2040.0004 <br />- fLTiprovel aXpirea OS-31-98 <br />a <br />FROM ~ ~ .' i TO ; ~ ', .. 7 <br />rzn.zu vz-z31 ruz5r rzbzn r28-131 r3a3U ~ NOTE: Reed inetruedone bNori compNtiny this form. <br />PARAMETER l3 Grd Onhl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> !46.53/ /54611 138.45 !4653 /5/-61 EX TYPE <br />l3Z-371 MALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsz-sal /64881 169-701 <br />':-. I SAMPLE .. ... - ~ ! ~ I, <br />II <br /> MEASUREMENT ~ <br />~.• - / - ~` , <br /> <br />' ~~~ ; <br />~ + <br /> <br />' ~ ~ " L - PERMIT .; ......~. ,_-,, f: {: ~:>t:;:^< ... ~;e{: > :~ ;!) 14 r, .; t5:;°/~ .~,l .~i <br /> <br />.[ -_ in.. REQUIREMENT <br />~ <br />`n1 -Y(! <br />"k 1-:) A4 <br />'n-'r <br />.J.1 rsr <br />'~,G;'L SAMPLE ~; =1 C. O <br />~ :: :: ;-;: ,t. ..:~. i:..' <br />r MEASUREMENT 4~~ I i <br />' M i' <br />D' : y~ ~ T.. . <br />a <br />• <br />~. <br />.. <br />. <br />n <br />~ ~ .. PERMIT . I ~ S I'; <?G33'" :a4;~ •:r': Y ~ <br />~ ' ".=b':.• ....- <br />: ~;:=i'1. : m4°~.~ i+Y ~ Y~5 j 1. <br />.I ` <br />' ' :REQUIREMENT ~ <br />' . . <br />~l 1 • I ' <br />~ a' <br />~ ,, <br />f'i : Y <br />~[F~, ;.'~ F~. r.AI <br />~ SAMPLE <br />EMENT <br />M <br />SU ... ~.. .. ... <br />L "? <br />~ ~ ( ? )) <br />' ~ <br />' <br /> <br />rLL EA <br />R <br />- _1 ~ ,~;- <br />., <br />~ <br />7 ~ <br />' :~ ~ PERMIT .:~.°.•>.. , ~. ~.k rPrl., >: ~ - kr: ' ~~: 1 '.F 1+`~~;,*. ~ / a;`4~k f i.~ $. <br />, , <br />I <br />~i I~ 'I ~r. :f REQUIREMENT ~ a`7~ Y. .f~).~;" ^.. r. l "' ^9 +.!"+~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <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 />NAME7TTTLE PRINCIPAL EXECUTIVE OFFICER I cFRn <br />AM FA FY uNOER PENALn of uW THAT I NAVE PERSONAUr ExAMINED AND <br />MILIM WITH TNF INFOrMATON SUBMITTED HEREIN; MD BASED ON - <br />~ TELEPHONE DATE <br /> MY IMDUIRY OF THOSE INDIVIDUALS IMMED!ATELV RESPONSIBLE FOR ;'{r' ' <br />~ <br />''`_I I I 11` L~ o I_ <br />Ire 7 f9 ~l OBTNNINO THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS <br />I AM AWME THAT THERE ME <br />ACCUMTE MD COMPLETE <br />TRUE <br />~ <br />/ ~~ <br />~f~ <br /> <br /> <br />-I <br />I )~ ~.~-~ . <br />. <br />SIGNIFICM7 PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING ~ <br />THE POSSIBRITY OF RNE MD IMPRISONMENT. SEE re U.S.C. E 1001 MD 1a „ <br />I <br />_ <br />BIONATURE OF PRINCIPAL EXECUTNE <br />_ _ <br />~~ I ~~^ ~ <br /> <br />~~ <br /> <br />)1,. <br /> <br />7 <br />/ u.s.c, E ,arB. rnww. uvr rA,w mron,,n,r hcxd, nN, ry ro tr0,000 <br />' TYPED OR PRINTED „wu-n..ri,w,.~'rwlw.,ewrrwbn...nemma,.nss rwal OFFICER OR AUTHORRED AGENT CODE NUMBER YEAR MO D~V <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Relerenee d/ ettscnmsnte nerel <br />EPA Form 3320-7 (08.951 Previous editions mey be used. (REPLACES EPA FORM T-0O WHICH MAY NOT BE USED.1 ~ _ PAGE , OF <br />