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n <br />Itil <br /> <br />PERMRTEE NAME/ADDRESS l1Mi6rF•cd~ry NaWLx•rrm lJDrpi.ar) <br />NAME r,`V near y:, ',,J i. V'i'. '('1AL ~~' <br />ADDRESS :: i ~ ~. ~ I , -~ ~ ~ ~' • '' .: C K 9 A ;. <br />FACILITY <br />LOCATION <br />. .*.: TtiIS 1'~ =1, s'-r•AL~~rP' :Y <br />NATIONAL POLLVEMT DISCHMGE ELIMINATION SYSTEM /NPDESI Form Approved. <br />DISCHARGE MONITORING REPORT IDMRI .,.,,OMB-No.,2040-0004. <br />l7-161 17-I9 "' N _ -. <br />_ , - ., ,,? , . ` Approved ezgiroe OS-31-98 <br />PERMIT NUMBER DISCHMGE NUMBER - _ ~ . <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 'T'1 "+ :' TO ~,,. r'li it ...;:. ,.n n-'r.l y: .. ~ <br />!767(1 l22-131 114761 116-771 179-191 !36311 NOTE: Reed In•ErueElom bef com Istinp thin form. <br />PARAMETER 13 Grd onlrl QUANTTTY OR LOADING I<Grd Onhl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> l<6531 !5461 !38-45 /4653 /5/-6I OF <br />137-371 EX MN.vsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-sal 164681 l6S701 <br />"~r:l J.: T'IYITY SAMPLE -;: r:-: .. ._;-1;:: r: r.. ~: •-,~-• ( 17) /1 <br /> MEASUREMENT <br />:r,c/a 1 Ct PERMIT .r;lp;:~•,: f.+>':•R.':'{:~ K •',::::" :_Y:~r~ts'-': ~f.pn.p~ n.[_+,r7~^!:EI • IMIn/ 1 ~'wirXir =:2R9 <br />~Y,.U.`- IT GtT lS ~_ VAL';; REQUIREMENT ~ :; n ng,q p. qYr flG'T T! M0.Y rw <br />. <br />".. SAMPLE I't;:hrxh': S"•,::c~~': ##nl:txt'_ ( 12) <br /> MEASUREMENT <br />~)t,"~vl' 1 I• ~ ~ :,PERMIT, tk G''~:k h.w,. .. ,. h.[: {;+ti :^: 4' C'.:^. :,• i .' ¢',Y Oic +•F,4 ~!: ~~~ ~ - 1 ');.>r',rb <br />Y <br />:RIIB <br />-~'.J3~?' ;A^?`' YA:. 'IE REQUIREMENT ~ ~ .-^rc wr qT~ij° *TAT K•. #:h ~'r ~ . <br />~~_I(15, ~F.''t'(.'.7SRLF: SAMPLE .. .., ::I:.rrt': Ar:......,., ( ,~) <br /> MEASUREMENT , <br />.)r7', I. `) i' l7 ') PERMIT ;: r,: •`:t r:>r :'. ,t ^: t,: :. y. yr.. ~; ;,e q^~rt o' cnFre'+. w- 'I ~.F~~. :PA v. <br />=''N:"i •,• .~;:L~V REQUIREMENT ri~•. ofl^t ASS r}.1 'FTY rX .,'./':. '". Milk ~:~ <br />i)!,~I?:i, ~5.°.TL"A•'L". SAMPLE ..~.5:'.,ir ~:yr.r:;t .I: f- ( ?~) '~ <br /> MEASUREMENT <br />: `)i.'] I ~ ^ PERMIT e;. `: fs ~., Lc ,.:k •t r: tt > <br />', .: ..,y w.t.Y.y:_... •,rn17m a <br />c ;'c ' <br />;J^ ^ <br />. , <br />- • C I? <br />. <br />/ i?A. <br />:;'LOF.'.^, G/'7~5 VBi^' <br />~ REQUIREMENT ecrkp 3r;~! tYr nlsly Wg qT/1, pryp <br />'j'N <br />'i r. AflJ 1.?~. is SAMPLE ...)(: r: r,.? q~t.^f: rS': .. :. :~..::.. ( t~17 <br />F~-,.:)'i } X"k-^'rk•! '+='~I' MEASUREMENT <br />''CG51r 1 C f PERMIT °fi, ~, Ct; :Y r: G-i: %: r-;:i r. s•rt~:•~ . . .. ... Tf r rl'1TT;~ ~h~,q- <br />t :' L I; :: I '.' = '1 ~ ^ Ii A , ;1 ' REQUIREMENT {: '•t p I ~. c n. a, y V "'' / T. .• ~: <br />~LI, .1, ::' I: '1~.^l?'' r'.P <br />* ` " " <br />° <br />` <br />` <br />' SAMPLE <br />MEASUREMENT ( .^.3) . ,,.; :; .. ,._.,w:::' ...'.' Ti <br />. ! T F: ' A ~ ° <br />; <br />. <br />7 a <br />I. <br />- <br />~UL`.Q ] p !) ~~PERMIT n>y.~;ra T.nrlprl4L +:~:;::rr'a ~. r:SCr,:kr a~~~;~. ~2F1,° 'y°.*p,~ <br />-'L;;; •; ~_ •~• <br />•qi II' REQUIREMENT iCP.S AVL' fiar;,s ~ ~ .'. r: <br />_ <br />%1'i ~'.U or: i SAMPLE 'C:- ( •, 1;) ...... .. ~:..-. ' <br />I ::_ ~, ;, L MEASUREMENT <br />'h.7 rl i. D C PERMIT ,.(t.~; Y;Y {, } ? .'°=1 <br />-.,.. <br />r: 'X'.. .~: !'e _, f: ek :3.. :Y,.'... > .•a t:. aaL'„Y rt °U4,. <br />.'_d.:T ':!i:)S' 4~,rT: REQUIREMENT T.iiT ii}; NCI_q - <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I OERTI FY UNDE11 PENN.TY OF UW THAT I HAVE PERSONALLY E%NAINED AND TELEPHONE DATE <br /> AM FA MILIM WITH THE INFO RMATION SUBMITTED HEREIN: MD BASED ON <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />/ ' ~ <br />Richard h"II~s I AM AWME THAT THERE ME <br />ACCUMTE AND COMPLETE <br />TRUE ~> <br />~ <br /> . <br />, <br />SE INFORMATION <br />INCLUDING <br />T <br />FOR SUBMITTING FN <br />T PE <br />E I <br />A <br />/.0/ <br /> <br />knv(rnnmentATl ~+tanayer , <br />. <br />SIONIFlCAN <br />NAL <br />I <br />S <br />THE POSSIBILITY OF FlNE MDIMPNSONMEMT. SEE IB U.S.C.I 1001 MDS] _ <br />$IDNATURE OF PRINCIPAL ExECUTNE <br />C Fl <br />'IQ-~]Tt <br />U <br />ZR <br />g] <br /> U.S.C. 1 t ]10. IMWd•, vW Mr ,nnm, m•Y ircFN, n., w ro S IO,OOD AREA <br />TYPED OR PRINTED .nso.+rr.,r:wn.rwrr,a+l~o..rwan.... s..lma,wsr..:l OFFICER OR AUTHORED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS /Re)ersncs s// efrochmenrs here! <br />,~ <br />.i iL°•.L- "f i-?'I" ~ iV (r'j^ .?,I ~~: LV ?^ 11:-~"0, 7I!-Vr iCnT~ -V~ :T T- r-L~T" 1. 'r` - .. <br />]~_ 1 r pri' [~ C >'~. I' n,. .P .-. ,• ,I -.5 r9_ rc Cr.:~ .~1~nv .~_ ..V /_v-11 Y ~ <br />EPA Form 3320-1 108-961 Previous editions mey be used. (REPLACES EPA FORM TAO WHICH MAY NO7 BE USED.( PAGE OF <br />