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<br />PERMITTEE NAME/ADDRESS N.rL4 FxNryNsWLacenm dDrp..v0 <br />NAME KEH$ ::1.{:, ^]910,!lY <br />ADDRESS tS A k Lt M C ti <br />P.U. P0Y 1137)7 <br />Sil:r1;780AP ~;~9Iy3 ~~ 3!1717 <br />FACILITY <br />LOCATION A A L i) Y N , 0 y U .{ 9 D <br />A1'iF: u::7R8c V. P'lit°•?S IV, `S I!i E' ".~'i• <br />NATIONK POLLUTMT DISCNMOE ELIMINATON SYSTEM /NPDESI <br />DISCHARGE MON{TORINC REPORT IOMR1 <br />11-161 I7-191 <br />~]ve50U37 003 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MON170RING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM J' iJ L TO UU 1 <br />110-Ill l11-131 /14151 /16171 118-191 !363/1 <br />_ _.. ___- ---_' .~~omi APProved. <br />Poil6 a/rRre ro cA~"il~'~°A304R-0~04.+ <br />(SDBR WR) Approval e~py rs ~05-31-98 <br />F - FINAi. 1 <br />ylNOa <br />A NOTE: Raad Inetruetlau before eomplstinQ this corm. <br />PARAMETER !3 find OnNI QUANTITY OR LOADING /I Gid Onryl QUANTITY OR CONCEN7RATION 1110 FREQUENCY SAMPLE <br /> /16531 !54571 l38d5 !4653 !54571 EX Ky TYPE <br />l3I 371 M <br />yg <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-sal /sq-5g1 169-701 <br />:'b SAMPLE i4::f: .7~G#:~ ~. .F ". .( 12) <br /> MEASUREMENT <br />JU7JU 1 U J PERMIT,~'~~~ Ry.##~~;: ~ rF#;xR##. .''.#;: 5,5 ~ #~::.'tk # 9.U ~ `$FALY ;tiSlT;l <br />:FPLUIiYt ;30:15 YAL:)E REQUIREMENT~ ~ ~ ~ ~~ ~+;=# ~ !4Lq~LCs'U+'i ~R,x.YZt`4U~!!- SU <br />. <br />~:; :.i Der ~:.PPLi:A~;LE SAMPLE G#C~.RG #•rsaao A`v i7.t-"i: ;- C4# hx ( 25) <br /> MEASUREMENT <br />JJ~1J 1 U 0 ..PERMIT. ~.~'~~ it ~ rYLt?p101~ . #SG ~RiE.$x#:# .. #'4F+Ar ~ jy.s <br />$~ <br />~~~ :: <br />, <br />~ i tll'F;/ :RAy <br />F`FL Ogi7 Ir „'~ST)[LUE „REQULRE.MENT- ~ . -- . <br />. <br />i'F>~ <br />~- <br />- <br />~437t~& <br />- - - <br />J L AN vii AS SAMPLE ~.##~#: Y#C#GU ?#4##4 CrF:k 4~ ( 19) <br /> MEASUREMENT <br />.IJiH2 1 0 ] "PERMIT .fix### ~F#+k#C o'=r ###CVits ;:#L~ >t 10 ( ONPIY :$A9 <br />.:FrLU:;,VTROSS VALUE REGUIREMENT rt=,# DAILY 7!% 9^,/L G°.f;T <br />~~ JP• h t.DND`JIl SAMPLE ( U3) 'k%r+~#:~ ~.. C.r#~"'~'~ <br />f F: .tU fRF: A'P !lHRi PLAFt MEASUREMENT <br />~OJSJ 1 D 0 PERMIT pTI]NAL RP.P]412 =~~+~r r°~;~~ ~ n>x~~nt: ~ rAl`--~ ( ~fiCf:/ 'MS`n?t <br />~F'FLUfiN? 0P.055 YALJr REQUIREMENT 3D,DA A7~ DAILY NY MGD ;-='~~r "77t7pii <br />AN R A SAMPLE #!'=~:.- ( 91J #~r {=:><~: .-„ #;~ Yt~t:#+: ;= <br />V Z ]UAL MEASUREMENT <br />;uoDb 1 0 D PERMIT .. ;:.##:=a iiE.P~RT T HS=1 «~'xYa#3 Y+;-~ a a~z~,=>"a r r~:t t N.^. f./ +j$i1;4 <br />:.FFLUEbT ;,ROSS VAL'JE .REGUIREMENT I11ST .'SAJE NO=D ~=Yr T;I <br />ri1n, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/i1TLE PRINCIPAL EXECUTNE OFFICER I ceanFV uNOER PEHAIrr aF LAw THAT I NAVE PERSONAUr ExAMINED AND <br />AM FAMILIM YATN THE INFORMATION SUBMITTED HEREIN; MD BMED ON ^ TELEPHONE DATE <br /> <br />uu,,..~. <br />Ric)1BTd A. CH„aeOn <br />MY INQUIRY OF THOSE INDIMOUAL9 IMMEDIATELY RESPONSIBLE FDR <br />OBT/JNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFDRMATION IS /l/ <br />( <br />// <br /> <br />nt <br />sid <br />T+i <br />P TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGMIFICMT PENALTIES FOR SUBMITTIND FALSE INFORMATION <br />INCLWING Y <br />r~r~r~ r~ 1.r~ <br />ce <br />re <br />e . l l ~ / Z~~Y (21 GO D4 07 <br /> THE POSSIBILITY OF FNE MD IMPRISONMENT. SEE 1e U.S.C. 1 1001 MD 35 ~ <br />SIDNATUpE OF INIWG-AL EXECUTNE <br />TYPED OR PRINTED U.S.C. 1 t 710. lFMWO„ uWr sw,r ,urrm, rrrY Ntrpd, rxr, l0 ro 570,000 <br />rp a~mulmun irrpl,vtnwltW Mrwwnemmrh,..d s Y.,r,.l ~ OFFICER OR AUTHORIZED AGENT CooE NUMBER YEAR MO DAY <br />COMMENTS ANO EXPLANATION OF ANV VIOLATIONS /Re)erencs ell sttschments hers) <br />SEIILEAbL2 S7LIDS LI:1It WAIVED FOH 10-YR, 24-ya PP.CCIP 3Vf.'ri ~u~Jivf 10 9L'RDEY 'JF PROOF P.E'UIccMFk!'3 IR <br />PAI:f I. 3. L. D, P. 5. St7R!1dATER 9A~A3sIgE;il PLAN DUE 1-1-3i. <br />F <br />` EPA Form 3320.1 108-951 Previous editions may be used. (REPLACES EPA FORM T-00 WHICH MAV NOT BE USED.1 U 2 7 1 /'7 7 0 U 1 9 - 1 2'. 4 PAGE i OF <br />