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 />
|