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PERMITTEE NAME/ADDRESS pnclude Fariury Numdlocarion i/Different) <br />NAME ,SYo=:7i ~~"nf 4' CO°P7?iTfh',' <br />ADpRESSf;PGL% 9i"~ ""1MFi.PX <br />CkAI`: ""? N,IF15 <br />FACILITY <br />LOCATION <br />A'liF: AG•:JPG^ - VA; n! Y.F. <br />NATIONAL POLLIlTANi DISCHARGE EDMINATION SV$TEM (NPDES) Form Approved. <br />DISCHAe GE MONITORING REPORT (OMH{s) • + ~ OMB No. 2040-0004 <br />Approval expires 05-37 -98 <br />^-1071 T+? M7 (C'!nn rrll <br />PERMIT NUMBER DISCHARGE NUMBER - p T „ - r r ~ ,. 5 <br />MONITORING PERIOD ~ ~ ~ ` °- i 1 '~ T ^ o ~ ~ n ~ ., r c :- <br />YEAR MO DAY YEAR MO DAY <br />FROM C T ] I TO n R ^ T T ~ :: •; i •~ - ^,- ~. q , - , .~ t ,,: <br />Izo-zp (n~z3) Razs) aszr) (ze-ze) i3w1) `•~NOTE: Read Instructions before leting this form. <br /> (3 card OntyJ QUANTITY OR LOADING - `: - (4 CetV Onty/ QUANTITY OR CONCENTAATION ` NO. FREOUENC SAMPLE <br />PARAMETER (4&53 59E1) °~ (3815 46-53 54-87 EX OF TYPE <br />(32J7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS <br />letml ANaL~Is <br />(64-68) <br />6370 <br />f~ll SAMPLE .. ,.:t:~ rY^?~. ...-, _.. r ''1 <br /> MEASUREMENT <br />UOU!IU I it ) PERMIT rXSSkRRC RR4adtY!<. "rc ~~:~, ~' ,~:9r41(t#ilr¢ - ~'.!1 N^a <br />/ <br />R A £~ <br />'FFLU°;N"' :;Pni~ YRLUS REOUIREMENT ~ ~ ~ <br />.~ r 1 <br />ay.', "1 t 1r _ p <br />SOLI'!S, ;•. F'Tf.°4 !Li' SAMPLE :.C+-: .. . . . -. ..rty ( . ':) <br /> MEASUREMENT <br />0U51+5 1 0 ;1 PERMIT A&a~R@t R91CIQir4 IQiROQ.IS"`, <br />~~ <br />":: 5 ~ IVCE~ AItA <br />'7 F F L U F, N T r, H E S S Y A L'! REQUIREMENT - ~ ~ p- M " i. / I a <br />U!L fi i;k`: A.i? SAMPLE <br />... <br />.`-^-G` <br />..... <br />i ... . . .': ._.... .r..4.t .. ( ' ~~ <br /> MEASUREMENT <br />UD`I~b :. ^ ^ PERMIT 4R4041M ,#@Y>A+Ar 441#O~C~.<' IltdfgPpbs l~ ~ O1/TIM pl1P <br />c:PPLUR'+7 ;:o'1i", 4AS.'1. REQUIREMENT K...:y - 4't` .4 ..-/r. . <br />FL"+N, T4 C7?;t r(ir ~ti• SAMPLE ( •'~i .. .. .:rt.-..-a.. .. ~. ~. ;.... <br />l'4fi'l) TkF'0.T!eVT i'L'~'I MEASUREMENT <br />tiUU'+U I 7 '1 PERMIT' iREBaR! RBP'JAf Cirt*#4a r#b~d4t O~IDI##IR ~~:t NCt/ M$'lil. <br />:'F'F'iIJENT GF.JSS VAL'I REQUIREMENT 7ODi! AfG DAI ~' !!! var. 'tt'`~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ <br />~ . <br /> REQUIREMENT ' ~ <br />' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ~ I ' . ~. . <br /> REQUIREMENT _ "" i ~_: <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WRH THE INFORM ATION SUBMrITED HERE IN, AND BASED ON MY ~ <br />Richard fe <br />tiilS INOVIRV OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BEOEV S IMMEDIATELY RESPON <br />E THE SVBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, - <br /> <br />F <br />ir <br />t3l ( <br />9 , <br />ACCURATE AND COMPLETE. 1 AM AWARE THAT TH <br />AT ERE ARE SIGNIFICAHr <br />D <br />T <br />~~ J <br />97O-HTO-2712 <br />IU <br />a ~] <br />T1V <br />0rl r^(?n <br />. <br />anager PENALTIES FOR SUBMrrTIN HE <br />G FALSE INFORM <br />ION, INCLU <br />ING I <br /> POSSIBILffY OF FINE AND IMPR ISONMENT. SEE 16 U.S.C. 5 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 4 1315. (PeneNas untler Nese smtutes mey MclutlB 5nee up ro t1fL000 end a <br />meximum/mprtsonment of OetNeen6mmthe entl 5y"ars.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY YIULA 1IUNS (rleremnCe all 8R8CnmBntS netB1 <br />.PT','LNA''.LF: `^Lf~q 1.?"T7 dgfY~'D POP >10!?.'g'!P ^iF:CTI 'Y^"t_cc^ T, S, "(e n^ ~(•• nin nc.1gT8Ff"^YT~. ° <br />~•uSA i? :',,A" '., A.. .+L.. A'I A.1.•;Ti f??~•tli 4cp I° ~l T'.T4L^ °,a<•,-y !.. ^Pq ~.. +; on, .;:,Tnr,, ^4 vvl.TF'r: T45rvr1f""T`t ',c-I. ".~'.. <br />EPA Form 332o-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) ' 0 ^ ~~ ~ ~ 0 ^ I 1 n _ T S? ,( PAGE ` OF <br />