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PERMITTEE NAME/ADDRESS (11d1i FwulryNaw/lIXenm UDlpw.wV <br />NAME rol:~r::3n_•:,:. _~1± rr..,eAnY <br />ADDRESS fI CJ A U-~ i :J r ~ .' r _I i ~., ... '. i. `.i <br />Y.U• .'iir t~i !:. <br />FACILITY <br />LOCATION <br /> <br />- ' " ~7ATIONAL POLLUTµi'OISCHMOE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT lOMR) <br />11-161 I17-191 <br />f'f' n. 7 7 n9 n <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM o f !~ •, (, 1 TO .'r ~ {; 7 n <br />116111 111-131 !1I-I61 116171 118-19/ !36311 <br />. - FoFm APProved. ..:- <br />PUI1D ':C CO LOPAt1~M~~~~'g~-oooa '- <br />pp o e bz{liree OS-31.96 <br />(St!F;R r:) 11)45 <br />- s'T,ISi. <br />'~ NOTE` Reed Instructions be1~ I tin0this Corm. <br />PARAMETER r3 Grd On/YI QUANTTY OR LOADING f4 Grd OnlYl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br /> /46531 !54511 138-~51 !16531 154511 DF <br />l3I-371 EX <br />µALY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rata]! 154681 f59-]Ol <br />~1L ANU ..i:tA.z'~: SAMPLE :, ...:~:.:;:r ( Y4) ;.^,,{:;r:y ::,:J!.L{:rl ;-~.;1'-;;a <br />~ .'~.; U A L MEASUREMENT <br />~-:l.oD 1 C'' ii PERMIT :::~.^.r,IIy;Y hEPOFfT Y F';=1 LY{rt,•Y~a{~ nr,:Or:::Y;< :;+~?drQ>,~' : ::-;: r: E(;KI <br />Y : <br />iSV- <br /> <br />Lf ^ L'J t!! I JI L:'i-~ VALU , <br />REQUIREMENT <br />N <br />6^_ <br />~ <br />Y/[:{:~ . <br />' • <br />. <br /> SAMPLE <br /> MEASUREMENT () s~ <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~- <br />NAME/TITLE PRINCIPAL EXECVTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMINED µD ~ TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; µD BASED O <br />N <br />/ <br /> <br />'' `` (1. AA ~,/ <br />~M~N ` ~/~//T~-/I~I25 ' <br />_` <br />~ <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FO <br />OBTNNING TXE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />r <br />~ TRUE, ACCVMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ <br />/ _ <br />~ (((~~~ <br />\ / <br />~ , <br />BI <br />TY OF FlN <br />MENT <br />/ 1001 <br />PN - / <br />~ J ~ <br />/ THE POSSI <br />LI <br />E µD IM <br />SON <br />. SEE 18 U.S.C. <br />µD ]J g1pNATURE OF PRINCIPAL EXECUTNE C/ / J <br /> U.S.C. 1 1]Ie. !/VIIFlBFF VIW tMw .YArn. nIFY MRrdr RMF w ro EIO,ODD/ AREA <br />TYPED OR PRINTED rl0w muirwnirplwnnvltW e.nrwn smmeu rW 6YFVa/ OFFICER OR AUTHOR1IED AGENT coOE NUMBER YEAR MO DAV <br />COMMENTS ANU t:AYLANAIIVN VH ANT VIULNIIONS fMeTB/BDCI e//erreenmenrs Oefe/ <br />,.':,;.tAULt ~ULiir~ LI^:, 6Pi•iIZS ..LY ::' <=1JYaF24H:+, P'i!s~IfITA'?'C!: EYPtiT I5 CL.4:F°C. t::~CI?T' 1}. ... <br />,.:nJEd uY PF.ULiI' 4dE'!. tti,',rJL:.'iIh~. %':.LI}F f'.iJ!' :i1,TTLEREL'i SULII;S ?fiiCApY LI~f"4TI`~:i. <br />EPA Form 3320-1 106-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />C0593/9ti C2'3-lc :t. <br />