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PERMITTEE NAME/ADDRESS pwebb FrWryNsWraauen rJDrprnr)
<br />NAME F'~MJ:}.tl(.:HY ('.1pi, C~1•.YAKY
<br />ADDRESS ttv ~'~~iU!. ".',cr A ~ :i POhTR LS
<br />r.u. Pr~'e ::.3.:
<br />FALIIITY
<br />LOCATION
<br />.i: ifli ./atl:• A. ter: 1`.. ~ I'ILOiLL`1
<br />NATIONAL POLLUTANT DISCHMOE FLIMINAITON SYSTEM INPDESI ForT Approved.
<br />DISCHARGE MONITORING REPORT IDMRI G B-S'fox 2p4f~-0 Oli --
<br />n s-r51 rn-r91 ROADSTCE r/2 34~T.P^,.., cq-•:+
<br />C C V ~~ 2 7 l4 fi C v^ 2 A (S U ;' F V C) APProveiexp~ ry a 05-31-98
<br />PERMIT NUMBER DISCHARGE NUMBER ~ _ F T F. A L
<br />MONITORING PERIOD i r' / "
<br />YEAR MO DAY YEAR MO DAY __ .,,,~;~,
<br />FROM Yi U4 1 TO '" '.'^ I' ~`~~`^ i:0 [:i::C rt.^. i•'. r. ~__~ ~'~'~~
<br />mm~ vvasl ousl nb~n rs8-191 13x311 NOTE: Rsad inatrlrclioru bslors complatlnp this form:
<br />PARAMETER l3 Ord Onlvl QUANTITY OR LOADING 14 Gro onlvl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE
<br /> !46531 !54671 l38-451 !06531 154511
<br />EX OF
<br />TYPE
<br />I37-371 ANALV515
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsa-ssl !yF-5B1 l5a7o1
<br /> SAMPLE ~ '::: C: ~' ~=?Y;: :~:;: ~: ;:},::::.7 ( i 1) ~
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<br />MEASUREMENT ~
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<br />r'FLUEMT 1;R0:5 7+L_:; REQUIREMENT Ddt:. 31J7A AVS 1iA; 1Y !'X '•G/L b']y~f :?
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<br /> MEASUREMENT N ~ - - --
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<br />MEASUREMENT ~
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<br />:. FF .,U L"': Li*.;:.~ C6L:1r REQUIREMENT j!; ;,' KAX 1:C=0 ::: t,
<br />NAME/TITLE PRINCIPAL E)(ECUTNE OFFICER I CERTIFY UNDER PEHUTY OF
<br />AM FAMILIAR WITH THE INFO UW THAT I HAVE PERSONALLY EXAMINED AND
<br />RMATION SUBMITTED HEREIN; AND BASED ON / TELEPHONE DATE
<br />
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<br />MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IB _
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<br />TRUE. ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE A11E
<br />SIONIFCJJIT PENALTIES FOR BUBMITTING FA15E INFORMATION
<br />INCLUDING /
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<br />THE POSSIBIUTV OF RNE NiD IMPIIISONMENT. SEE 18 U.S.C. 1 1001 AND ]3
<br />BIONATURE OF %IINCIPAL EXECUiNE - / I
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<br /> U.B.C. 1 1310. lhmlW.:rO.r N.r mrona nrY AecArl. ArN. W ro J 10,000 AREA
<br />TYPED OR PRINTED rawnwMUn MPriaau,wrrxwMrw«nsmmers rMe wral ~ OFFlCER OR AUTRORIZED AOENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/arance a!! sttacnments Derel v
<br />.Iti,~ OJT. :'n LL I; 80T eL::,L..L~ F'urt .. ,...,,>Ti'ISS F'f-..~5 TOTAL 'S:.P=4:FC ~CL;C; (75.;)F ":GTR;, T"'M AMU/~
<br />,r.;'iLEA:iL= SOLILS L7MiC6fLC~ti - ~kF: ~.A.~.
<br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 0 ~ j .l ~ / r ~ C , ` ~ _ L 2 _ t PAGE : OF
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