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PERMITTEE NAME/ADDRESS(lwiirb F.eYrryN~../rocana,pDiS...m) - -_
<br />NAME P041.cAHOF:. C:7„L :,: .. '. 'f
<br />ADDRESS :i J:,.: ;;IJ}. '"I aF'• ~ -t~.: It.AL_.
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHMOE Ei1MINATION SYSTEM (NPOES/ form Approved.
<br />DISCHARGE MONITORING REPORT (OMRI
<br />l7-161 I7-lsl RC A U S I C° C 31{ T C C~^Q~'!pA 2Q40"000
<br />L'' J J~ 7 14 F, C O 1 A (., J t F Y C) ApproveiexPJ roe, 05-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER c - F 11~ A L
<br />MONITORING PERIOD `• L ti ~ (:
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '1'i U4 ,:l TO `1 't _'J ~!0'4 M1C CI`; C; 'tA,; :.r ~~~~ •-~-~
<br />17P711 177-731 !74151 176-771 l76-791 !34311 NOTE: Reed InetrueUaru bdwe completing thb form.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Grd Ontyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br /> 146-53/ 15d-511 138-t51 !46-53 15451
<br />EX OF
<br />TYPE
<br />l37-371 ANKYSts
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167691 164661 168-701
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<br />NAME?ITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFO LAW THAT I NAVE PERSONALLY E%AMINED AND
<br />RMATION SUBMITTED HEREIN; ANO BASFD ON ~ TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS' - //
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<br />TRUE, ACCUMTE AND COM0.ETE. 1 AM AWARE THAT THERE ARE
<br />SIGNIflCANT PENALTIES FOR SUBMITTING FKSE INFORMATION, INCLUDING
<br />THE POSSIBILITY OF RNE MID IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND 33 _
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br /> U.S.C. f 1310. n°YrIFlr4. uW.r eMr moms mFy O,cAdA fim. w ro ! 10,000 AREA
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<br />TYPED OR PRINTED
<br />AM Ormuimnr 4rWrravnrrr Prbwwnemonel. rd6EVr..1
<br />OFFlCER OR AUTHORIZED AGENT
<br />CODE HUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION Oh ANY VIULA I IVNS IFrsreronce sn sRSOnmenr9 nere/
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<br />TCTRL 575 P£V!`F,;: SCLiC'i ("'JJ) r I.:'"A.L In'_!/ Ar:~/~7 t
<br />EPA Fam 3320.1 108-951 Previous editions mey bs used. (REPLACES EPA FORM TaiO WHICH MAY NOT BE USED.1 j ~ ? G ~ ~ ~~ ~ r. PAGE , OF
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