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y,,. 4 ,. - <br />pERMITTEE NAME/ADDRESS p1nY4 Frlaryxw/Locanw UDyG.mr) ' <br />NAME PU.G;,I•itC~-. '; r'vAL CJOYAF:Y <br />ADDRESS ftGna.'..iv'r. j"i ~ 4 ;; ~ PJ$inL-+ <br />P.~. DG.L L+,~;~ <br />YALE-, A: ,. Co ul~Lv <br />FACwTY <br />LOCATION <br />r.Itt.: Jwtd h. ~-:t•;,'-, r:c~It;t'hi <br />~NXTIONAC POLIIlI'1SNT D15LHMOE ELIMINATON SYSTEM /NPDFSI <br />- DISCHARGE MbNITORING REPORT lOMR7 <br />1-161 (17-79! <br />CU 0027 4 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 'i .1 V4 7 + TO '~'/ V ~ ~ U <br />!16111 l11-131 114-15) 12617/ 118-291 !36311 <br />Form Approved. <br />POND I T C C C CO P. A DoMe~oy;oho-oooa <br />It'pproveLexplres 05-31-98 <br />t' - F•InAI. <br />~_I:ca <br />NOTE: Reed inetructiors before eom letinp this form. <br />PARAMETER !3 6rd OnlYl QUANTITY OR LOADING 11 Grd Onlyl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br /> !4653/ !5481 l38-I51 !4653/ !54811 OF <br />l32-371 EX <br />MIN Y515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ls2.ss1 !Ba-sel 159701 <br />:a, iLhi, G!4EAS t. SAMPLE .. .:;::} ( 94) ::: re e,: r:., [+ :~, r,O,, r. ,. ,.,~~e S: <br />,, ~ J f. L MEASUREMENT <br />•e+v~~b I 0 V PERMIT is XF tfa}p14 :i~i'JIi'; L'S=1 C';-3 tl fly :};pyOr,. t~ ',: >}>:OS)>~ ,:;I-~ <br />'EGEt.Y ~'1'• <br />(I~~ni <br />..F'FLuEt:'7 Vr+O:i;: YALUF REQUIREMENT IggT. #IAX NU.U >'i0::: <br /> SAMPLE • <br /> MEASUREMENT /~j ~, ~^ <br /> .~~:~ PERMIT:.:'.: ... ..... . <br />~ <br />~ <br />~~ <br />: :~:.. <br />~ ~~ <br /> :REQUIREMENT ~~ . ~. .. .: ~ .:.. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~REQl11REMENT <br /> SAMPLE <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 /> PERMIT . <br /> :REQUIREMENT <br />NAME?ITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENMTY OF LAW THAT I HAVE PERSONALLY E%AMINED MID ~ <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN <br />AND SASED ON / TELEPHONE DATE <br /> <br />µA~ I 1 , ( ! (~~~~ <br />M w ; <br />MY INQUIRY OF THOSE INOINDUN.S IMMEDIATELY RESPON4BLE FO <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS~ e~ <br />r <br />{ <br />~ ~ TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE <br />AONIFICANT PENMTES FOR SUBMITTING FALSE INFORMATION <br />INCLWING l <br />~ ~ <br />/1 '1[YI <br />/// <br />/ <br />l'~1 <br />, <br />~ <br />V <br />( . <br />THE POSSIBILITY OF FNE AND <br />M%BSONMENT <br />SEE 14 U <br />1 1001 AND 47 <br />S <br />C , <br />, v _ <br />`I 1 <br />( <br />~ J/ <br />, <br />y I <br />J . <br />. <br />I <br />. <br />. <br />U <br />F tale <br />C BIONATURE OF fREINCIPAL EXECUTNE / ~ <br />J <br />r <br /> .S. <br />. <br />. IRAMdn uNAY enrr means wNF heA~d. rin.A w ro S/O,000 <br />/ AREA <br />TYPED ORP INTED Ane s•nr.imAn me.aN.r..rwwwwrs.nwea. redsrA.rAl , OFFICER OR Al1THORIZED AGENT CODE NUMBER YEAR MO DAV <br />GVMMENTS ANU EXrLANA1IUN Ur ANY VIVLA I IVNS !/rBTB(BnLB B// elleCATBnrS ABrB/ <br />ScTILtAnLi S~LI'e•5 LIC,I: ArPLIc~ o;,LY it <=1UY:./2448 k+4r:CIPITA:ICe FY;•_nT I[7 CLAi~EU. .'~y"I'PTc'F, .l r.,~ <br />nUn~dk VF e'~+UL)F' w!!ES L;.~UESTIhG F.~LICt' F,<JM ;. r. T'iLhAF L!: ~UL ILS f'FIM.I DIY LIMIiAYIC ~`~. <br />;a.l <br />EPA Fpm 3320.1 108-951 Previous editions mey be uaed. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED./ PAGE OF <br />GOSSH/95Ci[;l-12Sc <br />