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PERMI ADDRESS pnclude Faci(iry Namdlncarion ifDi$erenr) <br />NAME •Ui °YPfF• C^F^~?4TT')'~ <br />ADDRESS,. ,,p aL'7~' '~"PLF'S <br />C!-f,TC ~7 `11525 <br />FACILITY <br />LOCATION <br />ATTN: A(: -'Ok ;% U4.1~R_ J_P. <br />NATIONAL POLLUTANT DISCHARGE EUMINATON SYSTEM (NPDES) Forth Approved. <br />DISCHARGE MONITORING REPORT (OMR; <br />z <br />ts OMB No. 2040.0004 <br /> ( <br />- <br />l (n. 91 :. r rl ~ <br /> Approval expires OS-31-98 <br /> ^1!1'17 t~ 7 f1 •17 (;•I lQ ., 1'i <br /> PERMIT NUMBER DISCHARGE NUMBER ~ _ ~. T „ ~ t r . <br />N ~ <br /> _ <br /> MONITORING PERIOD ~ ° ~ r ~• -~ '~ T~ q r i.?. T A "'= P'1 % ' <br /> YEAR MO DAY YEAR MO DAY _ <br />FROM Z TO 01 QO ~r. ... .. .. "c r•r A;~r^ <br />I <br />lzo-z/) (zz-z~l !za-zs) (ze-zrl lzaz9) (sash NOTE: Read Instructions bet a Zr <br />Ieting this form. <br /> (3 Card Ony) GUANTITY OR LOADING ~ ' (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (a6-ss 5a-s1 (sa-as) a&63 5a-Br) EX of TYPE <br />(32-37) AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS ANaLrsu <br />6&70 <br /> rszml 64-68 <br />ALL nND GkSr"? SAMPLE . :ri^•C# ( .~,tl rvx¢*..~ .vc` ... .. <br />U I 5~ I A L MEASUREMENT <br />:14Qtf1 L D 7 PERMIT ::P##:/fr -7:.;:!`. K: .:'- ~'-] Df ". "".i,:##~clrb#". G44X~°.t t+ ... +r('f'l LSG11L <br />Ff'LII$h'° ~G"15`~ V41 <br />I• <br />^` AEOUIPEMENT ~:-~~~'~' ;Ll <br />' <br />I v'1-"~ ~ <br />' <br />. <br />. . <br />, . <br />~ <br />R R <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ~ :-'v ' ~ . - <br /> REOUIREMENT • - . ~ ;1 '' r",~ ~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . - - ,_ ~ r w x~:~ x "~~ <br />` "" '" <br />•~~ <br /> REQUIREMENT ~ "" ~ " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Ty <br /> <br />~ ~ <br /> <br />` ; <br /> <br />' ,; s~~ .; = <br />: , <br />' <br /> REQUIREMENT „ , ~ <br />;y.,' x - <br />• <br /> SAMPLE <br /> MEASUREMENT <br /> J <br /> REQUI~IEMENT ~: " . '- <br />r ~ ~ `~ -~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />AEOUI~IEMEN7 <br />• Ixk~ .,, <br />~ - „L,,~:,, <br />-~ <br /> ~~ , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~. 5 •' """'~'" " <br /> REQUIREMENT - s''~axxa" - - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDEfl PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINEO ANO TELEPHONE DATE <br /> AM FAMIUM WffH THE INFORM ATION SUBMnTED HEREIN; AND BASED ON MY <br />' 7 <br /> <br />Richard A/t{II`. INQUIRY OF THOSE INDNIDUAL <br />THE INFORMATION, 1 BELIEV <br />E <br />TE R IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />ARE THAT T <br />ERE ARE SIGNIFICAM ,- <br />~~ <br />IGG~GGGj ~( <br />Environmental r;!onager ACCURAT <br />ANO COMPLE <br />. <br />PENALTIES FOR SUBMITTIN 1 AM AW <br />H <br />G FALSE INFORMATON, INCLUDING THE 'V I]Q-B7O-2712 ID ~~, <br /> POSSIBILITY OF FINE AND IMPR <br />' ISONMEM. SEE 1B U.S.C. S 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 4 1318. (Penew <br />ss antler mwe s <br />maximum ~mpASOranerrc of beMSe mtulas may lntlude fines up b 510.000 Mtl d <br />n6monMS entlS yavsJ OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />SF.~TLS4;'L~ S~Lr': l.T"TT %r4i17?;1 pnv >j0~3~~0'{p noorTn -Y ..,.T-"c^ T.A.' n' .•.~ r•~o r=.In*pr.rc•,~5. ^Tr, <br />`..i2t.ASF. ;TAP SR'^l.` A`4LY5TS VPlLIjcF~ jT• Ur:-rn~c .-uci~¢ •1; n;q^,:oV^n~ ^°^~.iv ~, "/. Tv~T?!}C^'L045-L. .' <br />EPA Form 33267 (0&95) Previous editions may not be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.) PAGE OF <br />^0027/9^'It 2-] 52l <br />