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PERMffTEE NAME/ADDRESS priiLSrdgNsw/I<csnrl IJDIp..mp
<br />NAME C ° ~- '~ a ~- .. _ ..
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<br />9106 6P'_ "f'. ^.r ~?
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<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCNMOE ELIMINATION SYSTEM (IYPDE$)
<br />DISCHARGE MONITORING REPORT lOMRI
<br />II-161 117-191
<br />"2 1271:; nr7 A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM '+!t 1. '; TO "''~ 7
<br />!261/1 711-131 114151 !1617/ 718-191 !34311
<br />Form Approved.
<br />r ~ -. ~ ^„OM&No.t2040-0004:. -
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<br />/_„ ~ „ .~ Approval e~p~ros05-31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !1 Grd Onryl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> !'FB-531 !54611 138-<51 !1653 I546/I EX OF T
<br />731-371
<br />ANUres YPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !eI.691 !84681 (69-701
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<br /> MEASUREMENT
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<br />~:.LIU:ir :~F,T^:..'4'L°. SAMPLE :/AGx3rA R#F#'k~ ,;x*wr,xw ( IS)
<br /> MEASUREMENT
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<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cearlFr uNDEq PENALTY GF
<br />AM FAMILIAiI WITH THE INFO uw THAT I HAVE PERSOIIULr EXAMINED ANO
<br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />Richard Mllls OBTAINING THE INFORMATION
<br />I B0.1EVE THE SUBMITTED INFORMATION IS ~
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<br />nvironmental ~Aanager
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<br />TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ME
<br />SIGNIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />1970)870_Z!~1
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<br />THE POSSIBILITY OF FNE AND IMPRISONMENT. SEE 1B U.S.C. f 1001 AND J3 BIONATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. E 1 ] t e. IPwWNr. Insr tlwr .umra mry McAd. rwa y) ro s IO,ODO AREA
<br />TYPFD OR PRINTED me as muiman Mr/aomwnf o/e.w..n 6 manna.rld 6 fora! OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRderenes e// sttechmenfs hers! '
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<br />EPA Form 3320-1 (08.95) Prevloue edmom may be used. (REPLACES EPA FORM T40 WNICN MAV NOT BE USED.) ~ ., n n , / ~ ,, ~!! „ T - ~ ~ ~ !, PAGE OF
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