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PERMI7TEE NAME/ADDRESS RrL4FrdgN~.dLernlm I/DJAIn.v) <br />NAME 6U.llk. A~?i:lk~~5 LI"Ii~:D <br /> , <br />ADDRESS y U Y I k. 'V J. ). 9 I 'J <br /> V.J. !~ ~>'' 'JOJ <br /> VAUFLA C:/ '{IJ 2'J <br />FACILITY L (/ " I L' B : , :) ,; F ;; r. ~ . I ~~ I i <br />-~ U <br />LOCATION , . <br />J i' f. 1 r. <br />NATIONAL POLLUTMT OISLHMOE EUMINATON SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />17-I51 l17-I91 <br />PERMIT N 8ER DISCMMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM r D TO ~ <br />/70.711 /77-731 /14751 /7677/ /78-79/ /30.311 <br />Form Approved. . <br />I' D R D D D S (' H G ?' 7 F t t~ No. 2040-0004 <br />i+P rove! b>< Iree 05-/3II L'J8 <br />(~ruae ~~) l,,,r <br />? - FI~AS, r <br />MilJn-. <br />~~NOTE: Reed IrntnScbane befor eemplnln0 tltu form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !~ Grd Ontyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> !4653 !5461/ l38-451 !46531 151-611 OF <br />(31-371 EX MALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lst~asl lµ581 !59701 <br />-: L:. A9 ~ .:atA. ~. SAMPLE .3t R'?(a .x r <br />( I~;) e) <br />., ~r"` ., .. <br />h`~ <br />~:.}~"~~`~'~ <br /> MEASUREMENT <br />1 i~7P <br />L <br />, <br />'. ~~j ll '.i') L G .I PERMIT <br />.Yp ln"~.~'}'f•S. .y <br />~.R:'E~~z7T <br />E5=1 <br />'a G;Ys&CL <br />#ti~NCI .Z< <br />>rY: iK#4"~~A <br />/~f':: <br />'Y~ <br />P t <br />Y <br />~~ <br />L: J A I <br />.. <br />_- REQUIREMENT ~ <br />~ .. . , <br />~. .. <br />... .~ <br />. ~ <br />. <br />..M _ <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIT. ~ ~:. ~ ~ ~ ~ ~ <br />... .. ~ . ~ .: <br />.. <br /> REQUIREMENT <br />~ ~ ~ ~. .. .. ~ .. .. ~ ~ <br /> SAMPLE - -~ ~ J <br /> MEASUREMENT <br /> ~:': PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ..PERMIT <br /> REQUIREMENT ~ ~ ~ ~ ~ . <br /> SAMPLE <br />• MEASUREMENT <br /> PERM17 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERfiLE PRINCIPAL EXECUTNE OFFlCER I CERTIFY UNDER PENALTY Of LAW THAT I NAVE PERSONALLY E%AMINED MD TELEPHONE DATE <br /> AM FAMIUM WITH THE INFO RMATION SUBMITTED HEREIN: MD BASED ON <br /> MV INOVIRY OF THOSE INOIYIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE. ACCVRATE MD COMPLETE. I AM AWME THAT THERE ME - 1 <br /> SIONIFIGANT PENALTIES fOA SUBMITTING FALSE INfORMATION <br />INCLUOIMO <br /> , <br />THE POSSIBIUTV OF RNE AND IMPNSONMFNT. SEE iB U.S.L. E 1001 MD 33 gIONATURE OF PRINCIPAL EXECUTIVE ' <br />~ r' <br />~ <br />/~ ^I' / <br />TYPED OR PRINTED U.B.C. 1 131f1. lMrM.. uMr rMr mnm. m.Y MKAW lvwa W ro f 10,000 <br />.ro ar mF,.Ym.nNwiriMlnr of aN.rn smenev NMbY.val OFFlCER OR AUTHORIZED ADENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA TIOnS llfner4nce sn srtecnmsnts nerel <br />:'YiL':AaLc SULiG.i LINI." A?FLIES UtiLY Ii' C= iJ-Y.;, 24-t!R ?'"r,,:l.r ~Y.:..T Is ::LAI".ial. IF CLAI^I i:; ADf4;)'i:i~ <br />~+.Y w1(;J, 'T;iS IJ;J:7 L["ti'S MIL1. vUi 9c 4PPL[::J ~1 3F,PJftfF:C S:.n->L•ILra~o+i5 -'.'iFF I.'.IA, L"~ ` n`:7 I.f.1~• Pte. <br />' - <br />1:PA Fwr~l r3~fb=9"108`•861' praSidua dditiona'Mey bd•Lhed. ~ `~ ~ L - L -IREPtACES EPA FORM T-0D WNICH MAY NOT 8E USED.1 PAGE - OF <br />~~ 055'/''7;)314-!5J' <br />