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PERMITTEE NAME/ADDRESSR~4FrY~ryNa•/Locaua•IjD~in.p <br />NAME ,' u ° U S ~ "l <br />ADDRESS ~T ~ .S ~Lr Z", il`~' : r ~-'~ ` <br />FACILITY 5~ <br />LOCATION <br />NATIONAL POLLUTANT DISLNMGE EUMINATON SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT IOMRI <br />•- • 11-761 117-191 <br />PERMIT NUMBER DISCHMGE NUMBER <br />rl ` y ~ MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM '~ TO '~ <br />L ~° 4 ~~ l1a111 l1L231 114151 l1G171 l18-791 /36311 <br />Form Approved. <br />- ~ ~ + - .i • -r•OMB•No:.21YW-000¢ ~ ~• <br />' ices 05-31~-9R <br />r , .r ~ T APProve) a~P. , - <br />r - --•li <br />... T,..~ <br />+ NOTE: Read Inetructlorq belor com letinQ this form. <br />PARAMETER l3 Grd On/yl QUANTITY OR LOADING !d Grd Onlyl QUANTITY OR CONCENTRATION NO. FREOUENLY SAMPLE <br /> ld6-531 /54611 !3B-d51 !4653 1546/1 EX TYPE <br />l31-371 MA1Y515 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163-6a! /54681 /63701 <br />!~.:.=ti, T^iAL SAMPLE ~:-~{~3~fi F~' Sa::r': •: ~#",:~•: ! i4) <br />(65 F~) MEASUREMENT <br />..Lu'Ij 1 G ~ ~ PERMIT ,', ¢'X +h k,. •^-~~CS+,'< <t7: '=t:#~"* 3 <br />5 T <br />C ( 'N~f•/ :F <br />rn <br />;h"I.7::4T CNCSS '/4LL~ REQUIREMENT rk O:R . <br />a0?'A 4II^ . <br />p4T L? w.x "!('/L lRO4Tu . <br />'LO'/, LM C~Iv'1~I;' ~q SAMPLE ( 33) a4s~.~: -. ..,.r-;<,. ,_,.~.AA;: <br />- ~ •' TNF.AT`1B4P -'LAF? MEASUREMENT <br />SUU,U 1 U J PERMIT R°•PDRT PTIOpAI: ~'~'^~'~ *'"''y%'T t~IPs~>yN~ 1 fT;F1,Y 'N3T4N <br />': C':•il)f:\T GRDS$ V.11LU REQUIREMENT 3!)+)~ 1V~ DBiLY rY MuJ ~ ~ '%+<{' <br />'I'. AND -$NA ;" SAMPLE .'.n°.-,^. ( 34) .': (:•;: e': +:##t,. :.f `.. ~, :;: <br />y l , ~' A L MEASUREMENT <br />-i~C;;b L U D PERMIT {errs ~{=0 Y I?5=1 :e :k ~:;:-:: rr :?3?:SE'?IK. ,•.:. ~:•~: Y: fi...:_ p^K I,Y 'T ;IJd !, <br />'i .'~LUE.-T G3]!i ', REQUIREMENT .~ Z9ST *.AX NO=~' <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 cERn <br />A.AI FA Fr UNDER PENALTr of uw THAT I HAVE PERSONULV ExAMINEO MD <br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />`tlChard Mflls OBTNNING THE INFORMATION, I BFLEVE THE SUBMITTED INFORMATION IS <br /> <br /> <br />l <br />l <br />l : TRUE. ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIRCMT PENALTIES FOR SUBMITTING FN <br />SF INFORMATION <br />INCLUDING w <br />/ <br />~ <br />(970) 870-277 <br /> <br />6 <br /> <br />2 ~ <br /> <br />98 <br />anager <br />ronmenta <br />v <br />Env , <br />. <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE to U.S.C. f 1001 MD 33 BIONATURE OF P/IINCIPAL EXECUTNE _ <br /> U.S.C. !late. lANWM. unar eNrw memr. nMy Ncad~ 6r.r. w ro tlo,eoD AREA <br />TYPED OR PRINTED Avsnmui•Nnr MUrlsmm~r a/Mnvwnemwde rid6 y.w.l OFFICEfl OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReterence IN/ etteehmenfs here/ <br />T T r y: pnp pry ~ r: < aLv qn T C F F ;~. nr y rt Y T^ /- 1 <br />L::;r(!iA.t L,. I. :r ]. ) °r,.''t i.. D. (L~' ] ) T r_~r.r __n ru_••-•ro -'I-v•;•~' <br />i~ CLA I:;fF U. orv, T.l.7r ., L~, ~'?d 11J 17~-•' l° P?~~F ~('~; I'7a!'.cFl^ ~ r1 (?, .. mil`' -. .. :7n..,r „n p. r/ e <br />•I r.IT V ceNn1 r• r ocnr•:.*r• rv^ yr -•.rn• ^„m•enr nr r <br />EPA Form 3320-1 108-951 ^Prevloue edltlone mey ba used. ^ • (REPLACES EPA FORM Ti0 WNICH MAY NOT BE USED.1 ~ ~ T n • / rt ~ n!1 n 7 - I ~ j „ PAGE ,+ OF <br />