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PERMITTEE NAME/ADDRESS (include Faciliry Name/Locarion ijDi$errnq <br />NAME ,T.v~TyU~ ownrRl' rrF•,'•.:.4T!`JF <br />ADDRES~AGLh 9I":F ~7MpLF,' <br />~ i'~7. 9'Ix 59 . <br />FACWTY r~AI^ ~7 91f17(i <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(7-161 (1T- 9) <br />n7 T! <br />' ". PERMR NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 99 72 TO "'^ ^~ ~{n <br />(7U1f1 (~- . R4-751 R&71) (7&7D1 (3031) <br />wT..1n <br />Form Approved. <br />OMB No. 2040-0004 <br />Approval expires OS31-88 <br />^_ .. 1 ..~,..^~ I <br />` ^NOTE: Read Instructions befor' Rating this form. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53 (54-6T) (35-45 (4853) (54-61) EX OF TYPE <br />(32.37) AVERAGE MAXIMUM UNITS ~ MINIMUM AVERAGE MAXIMUM UNITS te7cal ~6q~gj' 69-70 <br />UIL AYD `.:FF.~SF, SAMPLE "`^RpR ~ nal ~e#4±.r .. - ... . <br />Y L`1 (; A L MEASUREMENT <br />,:,ul)f,6 L ;r ~ PERMIY 91QF9rC .. ..t, .. ,.: r.-=) ,~I y _,~#~i^#tt <br />s. Nd{r>U".,e td .. !iCf;~ L9UA <br /> <br />F'f'F'1.UF':T :?""' YAL!S <br />.REQUIREMENT <br />~+ <br />~~~ <br />rj~1r^ ;, . <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT M~ , `~ ~ .~ <br />s ~ - <br /> REOUIREMENT - ~ <br />,- ~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '~< ra :,•~ -:. :~' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br />4 _ ' <br /> REQUIREMENT ~1. <br /> SAMPLE <br /> MEASUREMENT <br /> - ~ PERMIT ~ z~ ~~, ', "~` <br />~ <br />` <br /> REQUIREMENT ; - .. .'. <br />.` <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT - = <br />` ~ 3~ ..~'- - <br /> REQUIREMENT ~ <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMI7 ~z - -' - .,~ , - <br /> REQUIREMEN7 k r -: ^' ~'` " <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF UW THATI HAVE PERSO <br />B <br />HER NALLY E%AMINED AND <br />AND BA <br />ED ON MY TELEPHONE DATE <br /> <br />Richard MI(IS AM FAMIUAA WITH THE INFORM <br />INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BELIEV S <br />EIN; <br />ATION SU <br />MITTED <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMRTED INFORMATION IS TRUE. <br />~ ~ ~~ <br />Environmental ^lana P_Y , <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />G THE <br />ATI <br />N <br />U // ~ ~ ~ 9~o-ego-27,~ ~D aY ~`~ <br /> <br />ON, I <br />CL <br />DIN <br />PENALTIES FOR BUBMITRNG FALSE INFORM <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S.C. 5 7001 AND 33 U.S.C. <br />, <br />SIGNATURE OF PRINCIPAL EXECUTIVE 1 <br /> <br />TYPED OR PRINTED g 1318. (f§nercles under Orase statutes may Mclude /kres up b i7oq'tl and ar <br />medmum impdsonmem of beMaen6morshs end 5yosrs.J OFFICER OR AUTHORD:ED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell ettacnments nereJ <br />SF.1'TL°A91.'. ';~L!' i I"TT :PI'S`:.^. F!?B )2~1P9~'D'{a ngFCT.F PYS'1°,-^r+^ I.~.i~ y. •nr r•~v rr+ttIReFl?pTa. rIT . <br />:TEASE GdA9 SA°?L° eNA:.t('IS Rr°']TR".D I° 9T~IPL~ SHEF!1 Ii ^a;ooVr~. ;o~ncTY "A"^LT!IC Ir41'Rnr~n7n!l~_T.-.', <br />- ~ - <br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />nn7Sq/AD04~,~152? 1 <br />