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PERMITTEE NAME/ADDRESS pnebm FrWry Nw~/Lrauu dDlQi..n9 <br />NAME ~) It `- T I v r , -I a ~ <br />ADDRESS ~i L d ~.:~ 1 ~ ~ _ ~ i w ~ .I r r <br />Wit:'. .. ~1`• ^n '~r}5 <br />FACILITY <br />LOCATION <br />^r, :~ 7;, ii T- r~ .. ,r .: yr - r;~/t:`S f, .4 !' `i r <br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT !D Rl <br />11-16I (17-191 <br />_7072775u (117 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM `I t'C TO ''" - " <br />114111 /11-231 114151 /16171 /1g-19/ !34311 <br />. _ 7-u.r <br />< ., a <br />Form Approvetl. <br />+• n OMBtNo~ 2040-0004..• . <br />Approve, szpires OS-31-98 <br />NOTE.' Read inetructiaru before o •plerinp this form- <br />PARAMETER 13 Card Onlvl QUANTITY OR LOADING !I Grd Onlvl OUANTITY OR CONCENTRATION NO• mEDUENCr SAMPLE <br /> /46531 154-6E1 !3B-151 I<653 154-511 E% ~Y <br /> <br />l31-371 515 <br />ANA TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS leaa]I !µ6g1 169-701 <br />?r SAMPLE .. %SStC h.`k; .Ar. il:` ( ~ ~~ <br /> MEASUREMENT <br />~; III:)'.; Z .". ') PERMIT t#hxx'< #.v#:' 1 #•'.:k 6.5 "?`: r,.!!s :k!r .)ten ~ otr~r <br />,.Y a <br />.PF. <br />JO'r'LUf~:r -,'l-c /AL!'~ REQUIREMENT #.^.kg gr9TwF1>R N4vrM•rw c.t <br />„ <br />,JI.IL~.`ir ~T ~AHLF. SAMPLE #RG`.SR gl##~#'r ###':#.'.: ~ <br />~S~ <br /> MEASUREMENT <br />si't5 - C 0 :.:PERMIT'. ¢#'#i0p ':.Ogcm# ##% ;#-k#;:# gEPt1o? RFPOeT ± ~Y^£/ %RRI' <br />;,:~: royi'-." `?~L7N :REQUIREMENT •':#3: )!)r!~ 4Yr., t~pi'T' ~+z "S S. 'S7N^'? <br />~.:,:. f.75~ ~.TTL~A9LT' SAMPLE ~.-~ ,,.rte., .'. ~k ( 251 <br /> MEASUREMENT <br />'•~':S L ~ PERMIT ;ttYk'k>~#: '.`•#:#;1'~ r#iRlkh# a-:..~On• n r r .Iv;/ ,n, <br />..1 <br />'r'Lflp:yi GR75- vALra REQUIREMENT .yy ~ '4nT•s 1y^. ;)A+'re ;:X :./L ?T TI"'+ <br />`:. AVU :aR£ASF. SAMPLE 'k :`~'k## •; ,••s .•, ###L`OL _.: ...- ( 1.~) <br />'"JY E;('pR-G RAY ""i'tI MEASUREMENT <br />. 'i': ~~, li 1 ~ .~~( PERMIT. '~- ~:+s!*=."-r. #fs .•4«x0~ .fit ?4.4' 'S'4rt.ntp,, ~-w...-..±t- <br />-~ ~ _~ 1•• rJ T!4 <br />V ~~~, ~ <br />~ E_ c~ <br />. <br />- -.It;NT GRQS$' ... REQUIREMENT "~'~~ 4t:h ~.1:-. vox N~/, ,.,, <br />'S7+ <br />IN CaNOOIT -' SAMPLE ( '7) ,^.#'-•. -.•c ,• ..=.:k ~--•-•: .. ... , <br />E <br />P' 1.• YR'c:82lIENf DLA'>"' MEASUREMENT <br />TIIIJ~" 1 0 '? PERMIT Rf:P ORY 3?TIOPtAL •r,.': i< ,-"t'="+# «~=~>.,.~,» ; r?^,./ ..,.._,.M1.., <br />. "pL'ldyp ~, ,;? YP.LCIp REQUIREMENT 300A AYr DAIL° Y;{ 'M G7 ':^.~,y <br />i~ N .?"c ;•' SAMPLE 'k#i#:;. ( 7f•) ~t-f. •- .«±, 4': ..-,`{x ~•°: <br />'~ Z:iq,4L MEASUREMENT <br />i405u 1 L' J PERMIT #*r#?Y# J T £:;.j `~AntE:•: .k': r,.,,t ~r:t ~:,,. ,, C.,.• rr FT.-v ' c.. ,I/ <br />Fr"LJ:... .~ 'i5 Yx!,!I': REQUIREMENT I"3 ' '±~C tin=0 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER AM F~ <br />i <br />n w <br />rH <br />e <br />y <br />T <br />5 <br />eI <br />N <br />Ei <br />o <br />D <br />µ TELEPHONE DATE <br /> il <br />l <br />A <br />l <br />T <br />INFORMATION <br />SUBMITTE0 <br />MEREIN <br />N1D <br />1 <br />is <br />D <br />r <br />i <br /> <br />itiekard .' Ille• MT INOUIRV OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 15 <br /> <br />// <br />]/~' <br />~ <br />e <br />{ <br />er <br />l M1l <br />a <br />-' <br />i TRUE, ACCUMTE AND COMRETE. I AM AWME THAT TNEflE ME <br />SIGNIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING / <br />/ <br />~ " <br />/ 4/~-8~0-?7)2 ~ ~F 99 <br />~ <br />:en <br />an <br />a <br />Fnv <br />ronl . <br /> THE POSSIBILITY DF RME MD IMPRISONMENT. SEE t8 u.s.t. 1 t00t MD 3] <br />M <br />' SIGNATURE OF PRINCIPAL E%ECUTNE <br /> U.S.C. f 1]10. IAVr <br />M.W ~i,r• to ro 110,000 <br />.A ulNr Mw NNM. .n/Y /'It AREA <br />TYPED OR PRINTED rMrnnrrnun inpl.wtnwNMMnvs.n snwnha rM6yASrA/ OFFICER OR AUfHOR1ZED AGENT CODE NUMBER YEAR MO DAV <br />GOMMENIS ANU tAYLANA I IVN VY ANT vw~n I t.+na Ins.ersncs sn rurcnmenrs nrra/ <br />°C :'l'L :F +Lc: :7 i, I'-^ LI'-T' Ci 'd ai6EJ (L.7~ re=rl 7''L? L`' J?.7-y- r ~'I-.. n-. _;.~ ..l ...r ~•- ~.r ,I' ~r. -~ -, e,7 <br />:r •.11{ 'f )•'~: 7w• Ir,r -:c^IIT /~e:i ~ l ~ 1--~.tc_ r r•' Cn r, r~rn 1 . •r <br />EPA Form 3]20.1 108.951 Previous edl[lons mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ^ ^ ^ c , / n ~~ r ~ _, ~ PAGE ) OF <br />