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PERMITTEE NAME/ADDRESSp Ydr FarMry Naw/Locmlw dD~inm) <br />NAME .. ~ ~ r .... - . _ . _ . _ _ <br />ADDRESS ~ ~i'~ ~ 1 r -- -~ ', I ~ ~ . -'..l i :~ R <br />fr..)1~ L~.;. ... ;.r _ .;i. <br />5 .. .... 'J 901i~ <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />13-761 lI7-191 <br />"';C~0171i4 nnl ~ <br />PERMIT NUMBER DISCN/JIGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM G TO 'I~' ' ~ ,,"t <br />(30-31/ 133-131 114/51 136-371 128-391 13P37/ <br />Form Approved. <br />•-• ~ F II ~ - ~ -. OM&Noc 2040-0OOA~. <br />... .. ~''. 1 APProvel axP,ires OS-31-96 <br />., , r .• <br />,. T, _. <br />... .- ., .. ~~. 1__I <br />NOTE: Reed Instructions before complatinp this form. <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !4 Grd Onhl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> 146-531 15461 138-d51 !46531 !5461/ <br />EX OF <br />TYPE <br />133-371 ANUVSS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is3-ss~ !5468/ 169-701 <br />_ ,..10 SAMPLE `. 2': C: ~. ~ r . .. .. ~ 1 71 <br />D <br />~ <br />~ <br />_ Q :' A L P F, C 7 Y it . f? ', F MEASUREMENT ~ ~j . I O ~ <br />_v~alJ 1 U ') PERMIT '.~~^'-:fF -`fi'Y:t 7F -',t .. x~k ~kY,:.!e:h 1~1~ Rrnr..: e. ' .{j 17F'I ~R".4 <br />Fr'1.7~NT :P~;S VAL7F REQUIREMENT #L:::4 9l??`A RY^ nA* NX r;/! xnera <br />'-i'.s ~R F!1P r,NPiAt.LT SAMPLE :`•R##vYA .,,-: R:k'.: ;`S#-t#'.`- ~,,~/ ~ • 7 <br />T ' / <br />I - S O L V? 0 MEASUREMENT • (..(~j~ . ~ (7~ ~,~ <br />':L J04 1 7 , .PERMIT ~:`¢~A'R# #R##ttM .. '=khrw". 4?PD FT a!: PL1p~T ~ ( >iCP./ iRE ^ <br />LU6UT GR~S~- ': r: :.UF REQUIREMENT ... 30OA ;0r: DA.T LT NX N!:~L T~n~Py . <br />)NPs: R• POTEN°. `? LLT <br />- SAMPLE <br />MEASUREMENT ., ,, y.:tr,: ~. <br />~ .--. _. /~ <br />O•~Jl~l <br /><O <br />l <br />( <br />JI <br />( 1~) <br />~ <br />3 <br />Q <br />C1 <br />~ <br />J <br />1' <br />S7LYGT0 <br />.: \ . <br />. <br />. ~ <br />j , <br />_ <br />~S, <br />i S()b 1. 0~ ~D PERMIT :?#p R+Q?;# <br />~ :;T'=kfi# ; r::':' >t e~Q~#:: n,n~~ n~" y;„~'/ ;-, i,: <br />"PLUc:NT 6ttD48 ~'P,LU' REQUIREMENT x`(k.. <br />~ .. : ~ ~ ~n~p Asp *.rrTV vv *f..'/T, ,,.ry,r'{ <br />. 'r '-. .;0.ti[?SE, ?OPAL. SAMPLE ~"`•``-~`•'•t` ;:7G ~':-- #^#^+`~: Q ! ^ T U ~ ^ <br /> <br />A 9 L F <br />: <br />' <br />'/ E P <br />MEASUREMENT <br />l <br />Q <br />O, ~ ` <br />~,d L <br />(7k~j <br />. <br />. <br />. <br />. , <br />l <br />i12f 7 . ., <br />i w~PERMIT <br />i; ..'=~~x 6RfF Ao ¢~g '~:7 °?r:~ :#'a ,~t:'.: ;bt'~^^ bFf-, :~.. ... I,r / ;oe~ <br />-'9r';,UE'~" '"" - VALUE. . <br />?REQUIREMENT ~ .. 3n~1 +I./~ ..ffLr ~T ,r _ <br />_ <br /> <br />~la9UIT' 08 <br />^ <br />.. a <br />~ • a -~ - r <br />~ <br />,yr <br />SAMPLE <br />MEASUREMENT <br />/7~)~'}fµ,I1H}1(QJ <br />~ <br />~~ ~ <br />( Jj) <br />.. <br />-... <br />.. ~//~) / <br />C ~ <br />y,~,~ <br /> <br />4 <br />r <br />r . <br />PLAN <br />. .. <br />h( <br />~7• I , l V V ~:1 L7F~ <br />_~;?5D 1 :: ') PERMIT RF.P DR7 pFn~R'" -. ..... ..... .- ;.;~~..t ;::•: { "A'~ <br />LJ?\'~ ~d":' YGf. ~'. REQUIREMENT 3DDA~ AVG 5~TLY Y~ hG~ ~ t-~~ <br />.~i. :'. :! ;hFB`i' SAMPLE #:RYAG .' ~ )Il) ;,........,::~ ~. Ax.._. ~.;. ~:a.::'.i:} <br />U L~ I_. <br />i I r <br />• j _. ~~ q L MEASUREMENT ~~ ~~ <br />_fi 1 U ~ PERMIT ,.'.`-R3LrR T ES=1 r;`~.'.•i: !~~t #tiA!- s` ... .. - - •. -ri,~r <br />L'IENT i,RUS' :T -I t• REQUIREMENT ZN.;T ~Ilv g(.-,ry , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />L'lcharcl Mlllfi MY INQUIRY OF THOBE INDINDUUS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IB ~ ^ <br />~ <br />+ <br />l <br /> <br />t , <br />TRUE <br />ACCUMTE AND COMPLETE <br />I AM AWN1E THAT THERE ARE I ~ <br />y <br />// <br />~~. <br />/ ` <br />~=iTV1rU'l lTlell tal <br />.]C7..O; I• . <br />. <br />SIGNIFCANT PENALTIEB FOfl SUBMITTING FAISE INFORMATION <br />INCLUDING ~ <br />v <br />' '~ O" <br />^ <br />, <br />• <br />• ~ <br /> , <br />E POSSIBILITY OF RNE AND IMPNSONMENT <br />SEE 1H U <br />S <br />C <br />! 1001 <br />T <br />D Il_ ~~,_ <br />~ ~ <br />_ ;, , I ,~ <br /> . <br />. <br />. <br />. <br />H <br />AN <br />3] 610NATURE OF PRINCIPAL EXECUTfVE <br /> ~~ rxwa Iq ro tlo,om <br />'r <br />vG~ !~ aa <br />~ <br />r a <br />ns~w <br />r <br />~ AREA <br />TYPED OR PRINTED w <br />s, <br />.~m <br />m <br />i.n <br />s <br />w <br />rwa/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLA / IVNS Irrsrerencs en arraenmsnrs oars/ <br />. .... ;+N'tT':' Lr'. T.,• .~. _ .T PL'~1 $:.~ ilL'..i (L"1" rlr) 49)rv n,;TY 'v !_ v_y' -ty_. ,. ..-•• ^v,... r_ <br />•I tT~-~ c T~ ~) _ i .'1 "'l t' lF i^-~]' ~'JI ~:o Il m~~ -.TT ~ ^n ^c__ _ ~~.. ~_1• v'/ 7~ _ <br />.. u. r .. I A r .. <br />EPA Form 3320-1 108.951 PraviouH editions may bs used. (REPLACES EPA FORM T40 WNICN MAY NOT BE USED.) n ,~ ~~ n ~,.~ ,~ n 11 _ T _ , ,1 T „ PAGE _ OF <br /> <br /> <br />