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PERMITTEE NAMElADDRESS (I~N44 F~ryNw/lamlm /D(Onmr) <br />NAME • <br />ADDRESS .. , . ~, .: . <br />• .. - f <br />C - . <br />FACILITY ~ ~ ~ ~ ~ ' " <br />LocATroN , . :: <br />T . <br />MATONAL POLLUTANT DISCHMOE EUNIien~iGn ~: STFL. !~CpJ_-~I <br />DISCHARGE MONITORING REPORT DhIRI <br />z-f 51 I7-f91 <br />PE 1.AI -NUMBER D6CHAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~~, I - , TO ~ I <br />!70111 l1z-231 !14151 !16171 l18-191 130-311 <br />_. ii .' .^. i. i <br />` - .. .I. <br />i .i i •,i~y..nr.,- <br />Appiovel'expirss 05-31L98 <br />~N07E: R~~d IlhUUetlaFr b~fao' oempl~dnp thb fam. <br />PARAMETER !3 fird OnNI QUANTITY OR LOADING !~ Grd OnNI QUANTITY OR CONCENTRATION NO. FREDDENCV SAMPLE <br /> ley-531 /5481 !3B-e5 465 /5451 GF <br />!3137/ EX <br />!µY5,5 <br />!' TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS M'De]I + <br />154-581 159-701 <br />. SAMPLE <br />, _ <br />I i :. .1 . _~ _ v ( ) 4) <br />~ <br />~ ' <br /> MEASUREMENT <br />•~ 1 ~. PERMIT <br />~~' <br />Tif'~~E~ = <br />#> rk;Y'," <br />.~•-t: o~t1: <br />:~~~ r: :>p~ _ - <br />'r` <br /> REQUIREMENT. .. . <br />~. ~ . r <br />_ <br /> SAMPLE ~ ~ ~ ~ <br />- <br /> <br />MEASUREMENT _ <br />/A~ <br />' <br />I <br /> <br />~ <br /> I <br />1 it . <br />~ /P <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 /> ~HEQUIREMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF UW TNAT 1 HAVE PERSONALLY Fl(AMINED AND - ! TELEPHONE DATE <br /> AM FA MILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BA9ED ON ~ l <br />y <br />~` I <br />~ _~ I `1 `~I` <br />Yl <br />MY INOUIIIY OF THOSE INDIYIOUAIS IMMEDIATELY RESPONSIBLE FOR <br />1 BELIEVE THE SUBMITTED INFORMATON 19 <br />OBTNNING THE INFORMATION ~ <br />~ <br />= <br />\ , <br />TRUE <br />ACCUMTE AND COMRETE. I AA'1 AWME TNAT THERE ARE i <br />j -'~ <br />~~ ~ <br />I . <br />SIGNIFICANT PENAlTlE9 FOR SUBMITTING FALSE INFORMATION <br />INCLUDING / <br />' " <br />t `~ ~' ~ Y7 _~ r\ , <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. F 1001 MID J3 ~ <br />610NATURE OF PIIINCWAL EXECUTIVE 1 J q, q-, -_ , ~ <br /> <br />~ l ~ ^~ r <br />TYPED OR PRINTED U.9.C. f 131Y. lPMW111i urWr e4a mnnr~ mrY MYIdF hM• .p 4t i 10,000 <br />.ndo-nrArinArr irlorlammNN OlMawnemmNartleYra/ OFFICER OR AUTMORRED AGENT ACODE NUMBER YEAR MO OAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRererrnce sn etreenments navel <br />• • <br />EPA For~3320-T Ib8-96) Previaua editions mey be ueetl. F (REPLACES-EPA fOR T-40 WHIC MAWNOT BE USED.) ' - ~ ~ • ' r PAGE OF <br />.1i ~'~'7) -~ ~~ <br />