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PERMITTEE NAME/ADDRESS 0sebi FrlbryNr'Lacum I/Dldirw.q NAME TRAPPER RINI':f:, TV C. ADDRESS T H A P P B R '1 [ N Y. P.'1, U]X 11+7 Ci'.~Ii; ;-? H1525 { FACILITY r LOCATION 1TTN: w. G]R11]N PETF.P~. PRB~/GaN gG3 PARAMETER !3 Grd ontyl 116531 l31-371 NATIONAL POLLUTANT DI3CMMOE EUMINATON SYSTEM INPDES) Form Approved. DISCHARGE MONITORING REPORT DMR/ .F r ~ .~ ~ OMB No. 2040-0004 1-161 17-19) ~]07321L5 X19 Y (^,l1R? !~F~ APProvelexpire~OS-31-98 PERMIT NUMBER DISCHARGE NUMBDi p _ f j r A ( r'1 ~. • -- 4^p'*? ecT '*FSTTKf, Fnr ~1~4 ONITORING PERIOD YEAR MO DAY YEAR MO DAV FROM TO ~`v 1'~ PT SCl11lPGv ~~~ t: fe:2 {20.211 1223L (14261 : ~ {26271 (18-191 /30.3/1 NOTE: Rod Instn+ctioru bsfon ~coimpletinQ this form. TY OR LOADING !< aYd OnlYl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE !54511 /3B-I5l //6531 1546/1 OF EX ANµVS15 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163-631 /5I-5B1 16¢701 C TATkg LLRM1R .4C/ SAMPLE r~RR3 R9rOi R~` ~3'"=+k~ ?=~':%:' ( ~ ;) . . C F. R I O+) A 8 H 9 I A MEASUREMENT AN3f1 1 L` J ;:':PERMIT^.::c; :. Ot ~..-. ~: : .... ;: :. ~?CF?fl ~ ~:.. #~4R ~;.II~.::~ '~:":::~::~::'.:.. :':~:.:$.~L.~.~."..%k..3r~.::::. :. ~...:.'F:~ir i<.Xta;~?.!:' ER- : .'L ?{. :. ;'~: ;:.. .t~ '~~:~' ~ ~ BPPLU.`:NT CR]SS VALU~ -REQUIREMENT .. ~~ .. ~: .. r;XGtr . ~~ ~~~~~ .. :. /-c^ . . , . . . ~ LCSO i'LAPHF 6NR ACC ' SAMPLE t"-F 443>t 4.t4, 4.~ S-'.`1XCt$k ,..t~'.t- ( ~~) ' - ~ PI!". P N A L E S EASUREMENT - ~- - AN6 ; 1 D 0 a:;~:;:PERMIT!::':.; '~~: ::..tiRCCX!:~i:% :::':i;. ~ ;.:~.>F:.,~:~. ORR ~ ~e si'::Li.n~. ;.>~.: ~~~ : ~:~.4#IS#..:. ~:~;:~ fF %x'A?.~`IG?5.~:'~. ' R- ~: : ~,'~ ~:_:;: ~ ?$.A~p.;... FFI OEt. '.R]55 VALU :REaUIREMENP ::~:.:: ...:'.:'i':::. :... . :::` ::.::...:..::. . .. LIRkII -:.::: .1~ :~n:°:`:'~~:aP,: .., ... I . ~..: ;;}t.:'.: .. .. _ ....:. -.. .::...'::. .... . r•~ . ^ . . . . SAMPLE ( MEASUREMENT ~ - _. REQUIREMENT:: : ~ • ..: . .: . ": ~ ~ ~ : ':; ~:%~ ~ :::?.::: ::::~ <~~`i~ .. .. : :~: . . . ~:. , ~ . . . . ; ~z~:.:.~.~•• .~ SAMPLE MEASUREMENT , PERMIT:' '. :.... .: ~ :•'f.::: :. I ,fiEQU.IREMENT ': ~ ~ ~ ... ,. ... .~.:.;... :. SL ~ .. ..:. ~ SAMPLE ~ ~' MEASUREMENT ' :.,r. :.. . .:::::.: ...... ... ..... ...:.:....: .. ....,.... ... r::,: iF. .. :. SAMPLE MEASUREMENT - .NEhUIREMENT.: : , . ~REQUI.REMENT:' .' : .::..........: ... ...:. .~' ~ ~::~ '.:::::'g .. ::':." :V:i~::. .. :.:.v::t;' ~::%.:i~.::'%%:.:' NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERnFr uNODI PENAITr of uw THAT I HAVE PERSONALLr ExAMINEO ANO ~ TELEPHONE ~ DATE AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON9BLE FOR *A! OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS GUrdJR Peters TRUE, ACCURATE AND COMPLETE. 1 AM AWME iMAT THERE ME ~~~ ~;~ '3?4-440: UU 1 27 Presidznt /General *Sanager 91GNIFIDANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDOiG THE POSSISIUTY OF RNE AND IMPNSONMENT. SEE to U.S.C. 1 1001 AND 33 610NATURE OF PRINCIPAL E%ECUTR/E U.S.C. ! 1310. r/wd./ ud~r tlwro mnma nrY YcNd. fil.. w ro t 10,000 TYPED OR PRINTED Ans armuim.n lAVianwno/bewwnemandrs rw 6YFrU OFFICER OR AUfHOR12ED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRererencs sll sflschments here) SEr T.A.1, PP 7-9, POF DETAILi f' THST D9JC.^'.DfIR?. 2FP]RT LCS!1 - STAT7ST7"'L ^'1~"" "T' ~ •/4Tt;P T`' Lf'TMAL TLS 50» OP 'f EST ]R;.ANLS?7S, ANU ATTACK ACU*E TJILCITi TEST RFPOP.^_ F7~+ ^T ~+o, r^,-.TT~ ns' ALL INFORKATION 1105T BP. S.NT 7 EPA. NR?N UPT f?STING AOt R$f~f+. POP ~!snT 4f,(~RCD°:Il-~~t~oF!'^ '~+et•nrv r1Y7y~ 7V 1`M EPA Fam 3320-7 108-%) Prevlow edlaons may be owed. IREPWCES EPA FORM Tr~3-W{ LfP.IE MAY NOT BE USED.1 U n t r, ~l ~ ,•f q ~ (1 -1 ~ _ I n Z ,• PAGE I Of I)