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PERMRTEE NAME/ADDRESS pwrYa. FsWyNadLermon dD~..wq <br />NAME <br />~ " ' " i .. ' <br />ADDRESS .: ~ - 1 ) ~ - .. ~ . <br />• I • .. <br />FACILITY ~ t 1 ' 1 9 .. <br />LOCATION <br />r ,. <br />NATIONDIBCHARGEDMON TORING REPORT (OMRI~uc,F <br />1-l61 I7-19 <br />PERMIT NUMBER OISCNMGE NUMBER <br />- - `' MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ '. ~ - 1 TO r~ ~~ ~, ~ t <br />~. ~ ~ !16211 l22-231 !24151 !26271 l28-291 136311 <br />c ~.:1 TI <br />`I 1i ~) <br />:' <br />Form Au proved. <br />on1tB~Nay zoao-oooaF{ <br />Approve{ e~ i~ee U531-96 <br />I ._ R I <br />.. .. .. .. I--I .; ... <br />NOTE: Reed Inetructlora Dion compleelnp thM form- <br />PARAMETER !3 Grd On/Yl QUANTITY OR LOADING !a Ore Onryl QUANTRY OR CONCENTRATION NO- HIEQUENLY SAMPLE <br /> !16-53 /5461 38-151 !4653 !6461 X of TY <br />E <br />/97.371 E ANALYSs P <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e2-sf! !64581 !63701 <br /> <br />` . •. 1 , .. SAMPLE <br />~ .. ~ <br />/!: { <br />.. <br />:. . <br /> MEASUREMENT <br />l{ n <br />L <br />. ._ 1 C <br />PERMIT ~ <br />.:rt iz>: <br />%[~~~~.CS <br />_ <br />,;:r', ~ <br />1~t>: .::k -'.. <br />..:. '. <br />4';,ri ..V <br />~~`>~} i <br />r <br /> REQUIREMENT ' ~ <br />' -. . C ' ~ - ° <br />E _ <br />- <br /> SAMPLE <br />~ <br /> MEASUREMENT ~ C ~ <br /> i C <br />- <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL El(ECIlTIVE OFflCER I eEan <br />AM FA FV uBOER PENALTY DF <br />MILIAR WITN THE INFO LAW THAT 1 NAVE PeesoNALLr E%AMINED AND <br />RMATION SUBMITTED HERDN; ANO BASED ON J <br />~ TELEPHONE DATE <br />i II (~ <br />I ~ [Ji I l <br />~' 1 + H MY BJOUIRT OF TMO$E INDIVIDUALS IMMEDIATELY RE$PON9BLE FOR <br />1 BELIEVE THE SUBMITTED INFORMATON 1$ <br />OBTMNINO THE INFORMATION , <br />i ;~ <br />>~ <br />, , <br />ACCUMTE AND COMRETE. I AM AWARE THAT THERE ARE <br />TRVE ~ / <br />, <br />~~ ~' <br /> . <br />INCLVDING <br />TIES FOR SUBMITTIMO FALSE INFORMATION <br />Ni PEN <br />G <br />RC ~ <br />)IZ .~ ~ 117 (y ~ , <br />SA <br />NI <br />A <br />AL <br />THE PO$SIBIUTY OF RNE AND IMPRISONMENT. SEE 18 U.$.C. 1 1001 MID 90 SIGNATURE OF PRINCIPAL EXECUTIVE /F ~- ~ I ? ~ ~ ~/- 7~/ <br /> <br />TYPED OR PRINTED u.s.c. / f a1 B. BwnMtl.. w.. ei.~ mrPn. nw Yldudr rmn w ro ! ro.000 <br />.nee. nrvinun lnp~I.omRnr PIMwFAn6mmeYS wsrw:.1 <br />OfFlCER OR AUTHORED AGENT <br />CODE <br />NUMBE(i <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRafarence N/ eTTechmenfs hs~sl <br />i - _ 1 l <br />EPA~Forlrl 3320-1 08-951 Prsvioue editions mey'tie used. IREPLACES'EPA FORM Tw10 WHICH MAY NOT E USED.I - ~ ; , _ PAGE OF <br />