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PERMITTEE NAME/ADDRESS p.rYd, FslbryNwWlaurm yD~irwq <br />NAME TRA-'FP.R 1[N('If:, L%V•^_. <br />AooRESSTEAPPI?R !7'iF <br />} P.O. BOM T97 <br />CHAfG Cr? p162o <br />fACILITV <br />LOCATION <br />ATTN: ~, GORD7R P''.'°EA_, PHES~G~:N ':GH <br />PARAMETER !3 Grd Onlyl <br />1~6-531 <br />l32-37/ <br />NATIONAL POLLUTMT DISCHMOE EIJMINATON SYSTEM INPDES) Form Approved. <br />DISCHARGE MONRORINO REPORT (OMRI r T V ~ t: OMB No. 2040-0004 <br />I7-161 17-19I <br />C. O D 9 2115 011 ~ ~ 79 P 5 V) APProval expires 05-31-98 <br />PERMIT NUMBER DISCHMGE NUMBEN F _ cT N AL M^ ~~ " <br />MONITORING PERIOD ~~q.FF Yp'" TP,;TTNC'. FOR D11A <br />YEAR MO DAY YEAR MO- DAY <br />FROM 70 - #t a1 DTSCNA",c ~~~ ### <br />(70.211 +2I-23) 44.451 1267-71 l48-29) 1363H NOTE: Mad Nutrucdarr bNon mplatinq this {am. <br />TY OR LOADING !a Grd only! QUANTITY OR CONCENTRATION NO FREgUENSY SAMPLE <br />151-6I1 138-~5~ I5b6~ gF <br />EX MAivss TYPE <br />AVERAGE ~ MAXIMUM UNITS ~ MINIMUM AVERAGE MAXIMUM UNITS /67-eJl rrr-Aal raa.Trn <br />Ch;ftIODAPHNTA MEASUREMENT <br />TAA3B 1 D D i3::;; PERMIT: .:•:: ~cYt',C;Sat:Z,:: :;::.?'JOIQF .. ,-:: ?:! <br />~. I`.~+ ":;: <br />:::( . .. ;CyR:IR`#(4'.L':. :. .#',S.##"~'~. >cp_ reg ::; <br />F:FPLUFNT C;RO`;5 YAi.U ?REQUIREMENT. ##aR . <br />. <br />EIS ~~.~~`$ rrryr <br />L'=5U STAB"~ 96HR AC' ' SAMPLE r3#3## asaaa# >a4###t t#r` ~ ~~) <br />PTHEPNAL~S -EASUREMENT <br />T A s d C L U U :..: gE .'Mlt::;; .. ~?:.? _:::::a1 tt a.... i::, , :~.'i `.,, .a., <br />~.:: <br />78A!I::: <br />FF <br />E LUENP ,ROSS YALU. OtIIR MENT <br />..;tr,~..:~:;„ :. . `.. .:.......: <br />::...:....::::-::'z :..: ::. ..: ::..:<::.;: <br />~.':.:..::..,;::;:. ###? '-SIl,YI4(~:EI;}i: ;,. .,: , <br />;..:.!':.:.'.:'..'. 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I <br /> . TRUE, ACCURATE MD COMRFTE. I AM AWME THAT THERE ME <br />SGNIHGMT PENALTIES FqR SUBMITTING (KBE INFORMATION <br />INCLUDING <br />I' Preaide~It /General :iena ei <br />S , <br />THE POSSIBILITY Of HNE Mq IMPRISONMENT <br />SEE 18 U <br />S <br />C <br />1 1001 MD 33 <br /> . <br />. <br />. <br />. <br />U <br />S <br />C <br />E 1315 <br />lP <br />I <br />m <br />N <br />4m f <br />!10 <br />000 BIOMATIIRE OF PRINCIPAL EXECUiNE <br />>" . <br />. <br />. <br />. <br />VW <br />ron. m,y <br />c <br />, <br />r. ~,O.r NAB <br />vN. w ro <br />. TYPED OR PRINTED ArN ar nrxwNAn nwl+NllwNWMnrwr6mmdu rtl6y.va) OFFICER OR AUTHORED AOENE CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/erencs s/l sttschmsnLa hare/ <br />:a6F. I.A. ', PP 7-'1, YCA ^°.TACL'; DP T25? PR7CP.DU4~. REDJRT L^_57 - STAT[STI'AI, P~L~;T ^~^i"+-^ ';f+TC`i 75 <br />~ Lh'TIIAL "•'/ SU 7F T'-:5T UBGAtlCS!SS, AND ATTACtl ACUTE TOYItIT'4 TEST BEPOA'" Fp4K T? nrD , !-rpT--~ -,c LLI. <br />F f"A U'- ~ vn -SIT r r^ veer,^- rv „ y <br />• <br />' <br />EPA Farm 3320.1 109-961 Previous sdi4om may be used. IREPhACE6 EPA FORM .40 US ..1 Q /1 D R S / ~ a (1 q ? I _ I O Z n PAGE ~ OF <br />~ <br />