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i PERMI~E NAME/ADDRESS piif.Nbry Nr.JL«.nn, I/DlQirnq <br />NAME <br />ADDRESS <br />, : ~ '. <br />FAauTY ., . ' <br />LOCATION - ~ I : . ~ "~ <br />NATIONAL POLLUTMT DISCHMOE E1IMINATON SYSTEM /lyvnf$l FORA AppfOVed. <br />DISCHARGE MONRORINO REPORT (OM91 OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />PERMIT NUMBER 019CHMOE NUMBER ~ • _ ~ ~` ~ <br />'--+'- ~ MONITORING PERIOD <br />Y AR MO DAY YEAR MO DAY <br />FROM - . , - TO ~ ~ -'L <br />- - (76711 112-73) 174761 176-771 778-79) 13031/ NOTE: RB~d klBtttutloOa Mtor~' c.mp7Atlt19 thN form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING /I GTd Onty! QUANTITY OR CONCENTRATION NO iREOUENCY SAMPLE <br /> !46-53/ !5451 /38.161 146-5 5x-61 DF <br />l37-371 EX <br />Agµyss TVPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /e7-e]I !64681 l6A 70/ <br /> SAMPLE <br />`-~ <br />~ ~ ~ - ~ ~ ( I ~ 1 ~ <br />~ <br />. MEASUREMENT ~ ' <br />1 <br />, <br />_ <br />.. <br />. ~ ~ <br />PERMIT <br />REQUIREMENT <br /> <br />~ <br />.. ri::.:.., ... <br />~ ..... <br /> <br />- <br />~ :.I/ <br />.:, ~ , ~'_ <br />,.. e, <br /> <br /> <br />- <br />~ .. r.. <br /> <br />;i ~ " r, :~',: ~ <br />~ ..~. a <br />~ :r@;; {.:, -. <br /> <br />.. <br />~. ~. <br />_ ..., , <br />.. T•.::. <br /> SAMPLE - ~ ~ <br />I~ MEASUREMENT ~ <br />I I it <br />~ <br />" <br /> PERMIT ~ ~ ~ ~ ~ " ~ <br />~ ~ ~ ~~ <br /> REQUIREMENT ~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> .PERMIT ECE <br /> REQUIREMENT ~ AUG 3 1998 ~ ~ ~ <br /> . <br /> SAMPLE <br /> MEASUREMENT ` <br /> UG 199 <br /> ~ <br />~ ERALS <br /> . <br />PERMIT ~ 8 GEO GY <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT 8 GEO GY <br /> <br /> .~ PERMIT. <br /> .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT .. <br />~ <br />NAMElTRLE PRINCIPAL EXECUTIVE OFFICER I CEflT <br />AM FA FY UNDER PENALTY Of LAW THAT I HAVE PERSONALLY EXAMINED MD <br />MILIM WITH 7NE INFORMATON SUBMITTED NERDN~ MD BASED ON /- <br />'~ TELEPHONE DATE <br /> <br />I <br />MY INOUIgY OF THOSE INDIVIDUAI9 IMMEDIATELY gESPON518LE FOq / <br /> <br />, <br />, t, <br />rl '~ II 1 <br />-rl N <br />~ <br />~ <br />A <br />S <br />E , <br />~ <br />'~ ~RUE, <br />A000RATE <br />AND <br />COM0.ETE. <br />E AM <br />AWME <br />THAT TMEgE ME ~ <br />1 <br />~ <br /> SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDMG ' l ' L- <br />I I` ~ V f Il ~ , <br />THE POSSIB0.ITY OF RNE MD IMPNSONMENT. SEE 1B U.S.C. E 1001 MD ]] <br />C <br />1 ) ~ I ~ ~ <br />810NATURE OF PRINCIPAL EXECUTIVE ~/7i~ -~ :.. ~/ '~ r ~)'' .• <br /> <br />TYPED OR PRINTED U.S. <br />. <br />t]1Y, eYn•rclu ripr V•w m,rm• m•Y icNM• N"r• w ro J IO,OOp <br />rparnui,l,m inq/mrwrr olMwwnemmer•rdbF.rat <br />OFFICER OR AUTHORIZED AOENi AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />VVMM[NIJ AMU CAYLANAIIVN VF ANT VIVLAIIUIYO IrteIBJBRCe se eTfeCn/ReD l9 n4/e/ <br />EPA Form 3J20-T 108.901 Previow editions m6y be ueetl. ~ • . ~ IREPLACES•EPA FORM T~0 WHICH MAY'NOT BE USED.) - • ' + F • • PAGE OF <br />