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PERMITTEE NAME/ADDRESS p.d,L faUlp Nwr/lamla UDI)Jw.n4 <br />NAME rYPRII: ... -. C' .."! ~.. <br />ADDRF,56 ~~ I Ir F J ~ r ~ '~ r ~ •, a ~ l ~ ,, <br />EVCL~...~ ^r. ,15~ <br />FACam <br />LOCATION <br />• PSV <br />NATIONK POLLUTANT DISCXAROE ELIMINATON SYSTEM INPDESI FOEm ApprOVed. <br />DISCHARGE MONITORING REPORT IDMRI - ..,.. ,, OMB7No.-~2040-0004 <br />12-161 17-191 ~ r ' - ~ ~ ~ i 1 <br />-, 0 ~1 ~ ~ 1 S 7 ~ ~ •? s / , ...~ Approval expires 0531-96 <br />^ PERMIT NUMBER DISCHMGE NUMBER - . . ry i <br />MONITORING PERIOD ~ 'T <br />YEAR MO DAV YEAR MO DAV <br />FROM 71 _. '. TO v ;~ .. .. ,: ..~ rl~r.l~q^n I i ^:;^.: <br />navn n7a31 nt751 v~7n n6aol (3o-3n +-NOTE: Read Instructions bafor . platlna this form. <br />PARAMETER 13 Grd OnIYI QUANTITY OR LOADING l4 Grd Ontyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> 146-531 15661 (38J51 /46-53 151-611 GF <br />132-371 E% <br />ANKrsls TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS Is2-4J1 (64-681 /69-701 <br />L,,ar I^! ._, iD'1';' „r SAMPLE ( )3) ..-- .. {.y....±•:: <br />I i~ •: li T F. F. A °_ ' '~ "; T ~ [, n •p MEASUREMENT <br />l,l'.-~f! l r ., PERMIT R€PJRT REPORT kts::r;:N ,-.r.-fit:; ,'.`•t'rr^, : ., pgYL`r 'N5TA1Q' <br />~~LU F:9T "-; vil. `!F REQUIREMENT 303 ;l/.,;~ DAI[.Y gY. MS1 <br />+ <br />I[n~i USr T'T'.L SAMPLE :a a: :r agar. r,.:r r,Ya~<;<-- ( <br />7 .1) <br />1:.5`7LVF.J MEASUREMENT <br />7 r',?~~S 1 ;i it PERMIT #k441 P:.~ aRAr ~Yaik ;:`~ :Si 2rY<Y:?: !?!?PORT R.F FOR'.!' • ."t"/ ."7`7 <br />'F•~. ul]%. ?rT ;i H'1 `.i3 YALUp ~REQUIREMENT - a+C^-.~- jr)f)j[ .~Yr nAYjY r'$ .r ~- [, ;7'7 ~^7 <br />.'iL F.Vi` :ii4R3? SAMPLE to ::nr,.gr ( Ali t. ;. _.. _Y... ,, x,.,... 'k3^: =i:+: -: ~:{: <br />~1 I S J 4 L MEASUREMENT <br />. rl l'Ay 1 3 ? ~ ~ PERMIT ~~ ':"=+~,:± ~f _ <br />!~"PJ?T v <br />im;=1 '"• <br />.~:~ <br />....,ham.. <br />h..w...w.. <br />~r[y <br />lr':1'. <br />-~rl"LU`.`:'" ::P.Di~ V4LOs REQUIREMENT r^15'^ p,aY Y^=0 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL E%ECUTNE OFFICER I ceenFV UNDER PENKTY of uW TXAT I RAVE PERSO <br />AM FAMILIM WITH TXE INFORMATION SUBMITTED X NKLr El(AMINED AND <br />EREIN <br />AND BASED ON ~ <br />~ TELEPHONE DATE <br /> ; <br />MY INQUIRY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOR / <br />/ <br />/ <br />y <br />7 <br /> <br />ach~rd "?Ifs OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS / <br />/ <br />// <br />i/J, <br />~/ ~ <br />/ <br />/ <br />/ <br /> <br />TRUE, ACCURATE AND COM0.ETE. I AM AWME THAT THERE NiE <br />SIGNIFICANT PENKTIEB FOR SUBMITTING FKSE INFORMATON <br />INCLUDING ~ <br />iL~!~/~,~(l~/ <br />/ ~ •*ri~'// <br /> <br />~ <br />~1`viror.rln:-ial ;.1.:~U]~'I , <br />TXE POSSIBILITY OFHNEANDIMPRISONMENT <br />SEEIBU <br />S <br />C <br />f1001AND33 97L` ~7Q-2712 ~ F `Irlr <br /> . <br />. <br />. <br />. <br />U <br />f 13te <br />S <br />lANWN. udr e <br />C <br />mem <br />A <br />Ad <br />r <br />r 10 <br />000 BIONATURE OF PRINCIPAL EIEECUTRIE <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />ww <br />x <br />. <br />xM. w ro <br />, <br />. m.r <br />sn4wmuirwn MVismNnt orWwwn4mmas.nde Fwal <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />Oqy <br />^.vmmo.. o nnv cnrcnnn ~ wn yr nn. .rvcn i wiw Inss.mc. wr srmannmrta nrre/ <br />:?I'. i ,; :'. i.., .` - 'cc p,, A„r: `/, .. 7. _.°`:D' n, '.'r'••"~C ! f °TTO _ ._ :n nT.. r,^ , n , <br />. %L` - '-1i~ "/. ."? ,"7:;LTltf9 <br />- <br />- i-° ,J^'+E `I~^ I.r -m[r•~r ~n .. r. ..~.,.r~.fL 1. <br /> r <br />EPA Form 3320-1 108-951 Previous editions may be used. (REPLACES EPA FORM T~0 WHICH MAy NOT BE USED.1 <br />., . <br />• <br />• PAGE <br />OF <br /> ~ i <br />, r <br />/ n a , <br />4 r~ _ <br />T -1 ^. T .^, <br />_ ~ _ ~ <br />