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PERMITTEE NAME/ADDRESS (Irid,4 F41gNmw/faanen dDlp...n0 <br />NAME -~Ypklli vf~• Y~?~ .. ~: 'iL~ :'DdP. <br />ADDRESS ~? I'-1 ~ S T r •- 1 , ' r - ,. " A C . <br />' 910 0' v n.:-^ ., T ., .., .. _ C .-. ^ <br />FACILIT/ <br />LOCATION <br />ATT~: "')u4f ~ I":'CL'• t. .'a %L Ant1Y <br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT (OMRI <br />17-161 lI7-191 <br />...~ ,1 r1 ~ ~ . - li n n ,1 L <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM `I U TO •'-d ";, <br />/]0.]11 O]J31 /]L]51 06]71 UA4.91 /30.311 <br />.. _ ... M1 ~ 1. <br />Form ADProved. <br />+,nOMB•Noa 2040-000¢., <br />Approval e~Cpires OS-31-98 <br />I , <br />'• NOTE: Raed Inetructione bafor' eo ~ IetlnO this Corm. <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !I Grd On/yl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> 146531 !546/1 l38-451 !46531 /5451/ DF <br />l37-37I EX Mursts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS !s]-691 164-Bgl 1By701 <br />LP,I4~r '":',"A L. SAMPLE .,`-~::..y X#R:;cR r,:pty...,,: ( TaT <br />(,• ~ :' ? MEASUREMENT <br />:/1J4 1 ^ 1 PERMIT fi~hx ~i- is h!t 4: ,x ,. ~;rk ?#'kYC^±t <br />~'n <br />7•^ <br />( <br />'9CP./ <br />~Rf.~ <br />F:FFI,U'':'l. _ '/1LDF REQUIREMENT ~ -,,x 3•~~r. I?V±• ^nTLY RX ;:/ t1N It <br />`~L7Gr 1. ~ _.; .^.'!~-P OR SAMPLE ( J3~ 9'.KYy',Y :k tC#': ;::5 :k X'.'.c^. ". ;: <br />° H~ L' P' F:., _ 'i L P L A H MEASUREMENT <br />~ D 0 ~~ U D ;! PERMIT <br />RBF~RT <br />)PTIONRI, <br />~Yr~O##~ <br />"=~r,s#rr +-+~ ~ Y ~. <br />.. ..# <br />a,;^ <br />F.EKL!' <br />~I;iTAI+ <br />:FFLU ~ ': Gf"`SS Yi 1_'1c REQUIREMENT 30DA ~pv ©IIILT t7C M;^. #"'^'~ <br />)IL .11i ~) ,vFA iD SAMPLE .RR~RO ( ?al ..., r~^- ,,.r -..,A ~.,.t r!~ <br />y j ; ; g I, MEASUREMENT <br />,[. ;.h5 1 D 0 PERMIT ~.: S^.--~. R: r T ~ Y fi=1 ::~~t:?: :- =ktf ~tR?::~: ..:`: S':::v ., ^~KL~: ISI?AL <br />~I- <br />' ri,J ENT GR~55 Y-T REQUIREMENT~: ~.:<,. IN~T 1tAX N0=0 `~ ~ <br />. - p <br />. <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 />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FM FY UNDER PENALTY OF U1W THAT I HAVE PERSO <br />!ILIM WITH THE INFORMATION SUBMITTED H NALLY E%AMINED MD <br />EREIN <br />AND BASED TELEPHONE DATE <br /> <br /> <br />F;iciTard f <br />:iiii ; <br />ON <br />MY INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />. TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME <br />r- <br />l:0er <br />E^ <br />vlro <br />~r <br />n <br />t~l <br />' SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ' <br />. <br />H <br />. <br />r <br />l <br />n <br />. , <br />THE POSSIBILITY OF RNE MD IMPIIISONMENT <br />SEE to U <br />S <br />C <br />E 1001 MD J3 _ ]~-f t]D- <br />.7T2 3 LJ ]y <br /> . <br />. <br />. <br />. <br />S <br />C gIONATURE OF PRINCIPAL E%E <br /> <br />U. <br />. <br />. E tS10. lPwrMrr uMrr ehrr rOrnnrr mrP 41celdr rrwr ~e ro !!0,000 CUTNE <br />ARE <br /> <br />TYPED OR PRINTED <br />.ianmrxrnun 4rlFdrnvrwrarMwwnsmanelr r1067.rn.1 <br />OFFICER OR AUTHORIZED AGENT A <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />{:VMMLIY 1 i AMU CArLA1reN I IVIY Vr' NrvT Yw~n I was Ir,ererence an am0nmenrs nnq <br />1L('`.N.VAT; ! ,".T'. ;-rJr ~~~ T•-0^.y - 5''TfL=' TL' ;'iLln; /I-'1' r. t~ lo.ITY nvLv T^ /_ 1 ^_v or 7L'-. nrl,.~T.. .l- +' <br />~'.,.4I1i:D. ~~ T. .7. "- ~ ^`cw gnq~cv ~^ ^'7 r cc C" - - <br />!Y E^^ - - D' rvc n-.1o(lu> n~nnunno n/ <br />EPA Form 3320-1 108-961 Prevloue edmone may bs ueed. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 n ^ ^ c n ~ ~ ;~ ~ I? n ~ _ i ~ .; n PAGE ~ OF <br /> <br />