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PERMITTEE NAME/ADDRESS Pr.drb FrdrryNwdLr,rlm IJDrQ.,nr)
<br />NAME "YP ;"r -•-_ - __ .
<br />ADDRESS!-•INL.i 1F /.;? •-•I~; .,.F ~ ~ _`!ryAf+~n:
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCNMGE ELIMINATON SYSTEM INPOES)
<br />DISCHARGE MONITORING REPORT lOMR1
<br />11-151 I17- I91
<br />.1OC7715r1 ^'1~ a
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM '{ TO ? 1
<br />!16111 l11-131 124151 116171 /15-191 l3P311
<br />Form Approved.
<br />~• - ~ ~ - ~~ -~,OMB.No.,2040-0004 -
<br />! ~ .: ~. ~ 1 ~ Approval e~fVires OS-31-98
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<br />NOTE: Rsad Instructions bs1 s co plating this farm.
<br />PARAMETER !3 Grd Onlyl QUANTfTY OR LOADING 14 Grd On/Yl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> 146531 !54511 lie-451 146531 /54511 GF
<br />131-371 E%
<br />MALYSIS TYPE
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS l61-ef! l54-5B1 159-701
<br />L i:.i .`%~ '!: 'J ~.,.L SAMPLE ahrr## 4rkXrt--.`- r, •;^.•••. ,. ( j ~~
<br />;t; r ' MEASUREMENT
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<br />~F::.C.;','; -'-~;~ Y4LUF REQUIREMENT R~:~S 304 PV> OAT .Y MY `IG/L tl~N ?f
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<br />,L'05, _ , U PERMIT REPORT PTIONlIL ~#lt7t?=~ L+#~#rx^ ~t>aarfi = #:Y ^: EEFLY •NSTAN
<br />cF':-6J ':': :,455 YkLUF REQUIREMENT 30DiI k9G ~ nIIILT I7Y .'1111 #~e ,-r:
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN
<br />MD BASED OH TELEPHONE DATE
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<br />Richard h4111 i MY INQUIRY OF THOSE INDIVIDUN.S IMMEDIATELY RESPONSIBLE FOq
<br />OBTNNING THE INFOMIATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />t: TRUE, ACCURATE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIRCMT PEMALTIE9 FOR SUBMITTING FN
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<br />EPA Form 3320.1 108.961 Prevlous edrtrone may bs used. (REPLACES FPq FORM T40 WHICH MAY NOT BE USED.! PAGE _ OF
<br />,,~~ l=, /`:a C'1'17-117^ ,
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