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P£RMITTEE NAME/A <br />NAME ~ v " ' <br />ADDRESS '~Y= ~~ -~ <br />~, alb„ <br />CtJ ~... <br />)DRESS pnryb fecdbyNrWTaanon UDrp..rrl <br />'/• J F -. v l M A <br />.. ;.r .I .ri 3/11 ll <br />FACILITY <br />LOCATION <br />„IY~: yp, rT .GLF'y, -°rFRAT. °.'9'i <br />NATIONAL POLLUTANT DISCNAROE ELIMIMATON SYSTEM INPOESI <br />DISCHARGE MONITORING REPORT IOMRI <br />7-761 117-191 <br />PERMIT NUMBER DISCMMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ::. ') TO v_l ,~ .11 <br />1167// l71-131 114761 136-I71 128-791 !36311 <br />:~vc . `.~^q7 <br />'~- • l <br />~ . .. <br />Form Approved. <br />7.)OMB,No~ 2040-0004 •,, !- <br />Approve, expires OS-31-98 <br />.~:. w-I ^I-ri. rl e~. ~. I ..n .. <br />~` NOTE: Rasd Instructloro baforl c gtplatiny thb form. <br />PARAMETER !3 Grd On1Y1 QUANTITY OR LOADING !/ Grd Onlrl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> !46531 15b611 l3B-451 !46-53 (5b611 OF <br />l37-371 E% ANUrss TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS fe1~e]1 !64661 /69-701 <br />I °';Y/ 'i G'f'L SAMPLE F4 ~:-;= a.~..F X"'t ., ;esT;,t ~: ( lr)~ <br />(q g - • 1 MEASUREMENT <br />)_U4~ 1 ~ :' PERMIT 3tihZz'k# r-xOG:r G+:.`- :-?~Yfi'::h j.5 '. (.) ( N^F/ '~Y.~ <br />`'E''LUeNT GI?~JS v1lr tip REQUIREMENT A~~ QFf ,q AV!' TAT*Y ^+X R`/1. )p' <br />''L )Y/ I5 :.J': 7'JIi ~R SAMPLE ( J3) rfk::•':fi .' #'k~.. dY'.`. , <br />i .. d'J i H E ~ "i ^ ° N P PLAN . MEASUREMENT <br />SUi/70 L U () PERMIT 4~YPJ@T ~P*IOxAL CI?#bl'FG %'/fit"-'Srffi ;~+^I~~Nr,. ~•,`•t ~$~g;LY .NS'j`aV~. <br />'.PI'LUi:YT :+R~iS VALU= .REQUIREMENT 'J ;1UA 9Vi 7AIyY '!~' %(:,7 ~ ~ ':r;# <br />I !. A N J G R F. '. `~" SAMPLE .. r G r ~ ( J 7 ( • ..• fr •:'~ ,~ #•- "i`-'` ~: ~`#.'.:'.`-'.- <br />. L ~ li A L MEASUREMENT <br />--l~~ia 'L D ~ ~ PERMIT. :~e-".Ixi~fF 7 Y F`•_1 ~'~`~'::':''- !,`.,- F. <br />~:Pi Lil fi tlT 6A05> VALU' REOUIHENIENT kyy <br />zNSr: epoU ,p.; .... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />.,'Y 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 E%ECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> <br />l~~° <br />~~f]hD'1•C'T ~ MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNMING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ <br />~ <br />/~ <br />i <br />i TRUE <br />ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ME ~~ <br />~ <br />/ <br />n <br />t <br />l " <br />! <br />F <br />i , <br />SIGNIFICANT PENAlTlES FOR SUBMITTING FKSE INFORMATION <br />INCLUDING ~ ~ ~ 37i-?~n-??'~ z n 7 p <br />a <br />ana <br />. <br />er <br />w <br />ronnen , <br />TH <br />IBILITY OF RNE AND IMPRISONMENT <br />SEE 1 <br />E 10 <br />S <br />C C. 9 <br /> . <br />E POSS <br />B U. <br />. <br />. <br />01 AND 33 SIGNATURE OF PRINCIPAL EXECUTNE <br /> U.S.C. E 1]te. lMrro++r.er err moms rn+P IxAd+ r/rs w ro ! 10.000 <br />TYPED OR PRINTED +ntlwnM+/rwnMnm'mlm+nr e/bM//n enronlAa Anse Yeva/ OFFICER OR AIlTiIORIZED AGENT CODE NUMBER YEAR MO ppy <br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS (Reference e// sftschmenrs here! <br />.,. "r nN ~..... f.'.r.- :•(!c -;/ ~.. ~~~ - ...P PL~:q~+L~ >~, r~5 (L1^ rlE1 T•~.rv n.;ly r., i- ~n_. :/ ^Ll-c ,_r-.-r ;,r„ <br />.~.i CL 1I .'1 ~I+ .. Te `.l+ La/ tap/^r~ ]T• go~np rp',n l~r Mrr ~.-e 1Tr c fir- _- ..1ner ~•~ c~/ ~~ 1T+ <br />r(y tMUFT~^_ {' C"^1t •'r••r r _r.: ~•'•. r.l ••'.c ~•,m ~•n,••: n/ <br />EPA,Form 3320.1 108.951 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) O r -. n , ~ O o n l1 n 7 - T ~ T ;' PAGE ,, OF <br />