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PERMITTEE NAMEIADDRESS (1M,4 FsWry N~/Tuanan dDlp..c•q
<br />NAME ~;Yr .I' '. rr y .• •L .^DrP•
<br />ADDRESS ~ i , - i - _ y, ~ A .: ~ t
<br />FACarrv
<br />LOCATION
<br />NATIONAL POLLUTMT DISCNMGE ELIMINATON SYSTEM (NPOESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />1-151 I7-19I
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM I C '. TO '+'• n? Tl
<br />!70.7/1 l17-131 !7(-151 174771 /28-791 /30-311
<br />Form Approved.
<br />^ n o ...• + r •.; r T r^ •- r -OMB f{o.2040-0004
<br />I T _ r • ~ Approve4 expiroe OS-31-98
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<br />NOTE: Read Inetnletioro before.eom Iatinp this form.
<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING /4 Grd Ontyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> /16-531 1548/ l3B~51 !4653 !51-51 of
<br />197-371 EX Mursls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-IJl l8L881 189-701
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<br />.f''r' .C1• STATILE /' ~ v SAMPLE 70 ¢fc .; r:rc{''.+'..- .: r. ~. .: >;::. ( )1
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENUTY OF L AW THAT I HAVE PERSONNIY E%AMINEO MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFO RMATION SUBMITTED HEREIN; MD BASED ON
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION
<br />I BELEVE THE SUBMITTED INFORMATION IS -
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<br />Richard Il'~~I$ ,
<br />TRUE, ACCUMTE MO COM0.ETE. I AIA AWME THAT THERE ME
<br />SIGNIFCMT PENALTIES FOR SUBMITTING FN
<br />SE INFORMATION
<br />INCLUDING /
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<br />THE POSSIBILITY OF NNE MO IMP/1150NMENT
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<br />1 1001 MD 3 970 879-2712 I( 24 99
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<br />7 810NATURE OF PRINCIPAL EXECUTNE
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<br />' "TYPED •Oh PRINTED ~- U.S.C. F 13t e. lAvrbry~ nKr tlw~ mNn~ nny inlld~ Firwi W ro 110,000
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<br />Form 3320-1 108-961 PrsvTOUe sdlnone mey be used. IREPLACE6 EPA FORM T-40 WHICH MAY NOT
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