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PERMITTEE NAME/ADDRESS pM.b FrWryX.w/lneanw r/Orp.•.np <br />NAME !- v '~ . , . r ~ t .. .. _ . , . ~, ~ <br />ADDRESS ~~~ L .:... 1 F ~ _ ~ ~ ~ r ~ ~~ . ~; + q w o T <br /> :13,)0 tr,. T`. - _-".C'. <br /> .':L'.,~~ ..) r ail 55 <br />FACILITY <br />LOCATION <br />.:a: +1J':HI.. E~r.''L`~'r --'~'' ?1L rrv. <br />NATIONAL POLLUTANT DISCXMOE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMRI <br />l1-181 17-191 <br />.:7C727177 l:~r <br />PERMIT NUMBER DIBCHAIIGE NUMBER <br />MONRORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 'fy 1J Ji TO 4'< ^ T <br />!1611/ l11-131 !14151 116-I71 118-191 !36311 <br />Form Approved. <br />.. ~ c •• . -~~ v ... ~ mnOMB)No:2040-000 <br />7-„r„•, ,. _.~ Approve! expires 05-31-98 <br />r _ or•, t• <br />.., ~ r r! <br />x NOTE: Read Instrucdoru bafor com htlnq this lorm. <br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> !<s-531 154811 I3B-051 1a6531 154511 EX GF T <br />PE <br />131-371 ANMY515 Y <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is]-sal !8<-581 159701 <br />rLJVA IV ,:")V7"rT r1^ SAMPLE ( J)) .: t:fCfo:v'a ~r:~':~::..,. <br />Iii.{,' Ti1EtT.54. '+" DL A~•~r MEASUREMENT <br />TU')'i0 Z ;) r PERMIT RFP)Rf L2Ei'!14T .'`~~'•'"" r-:~`r'Q'= "•.`+:"^ F.=l"Ly ')fiiq'. <br />:F'L+J~:'r'" :;H7'' V4T-'!c REQUIREMENT ~UnS \VS. DAILr MX !±!;D <br />~iOLi DS. 1'UTr:L SAMPLE t`+,"-RR.`•~ CGR#fA iZ R':O#••:: ( T9) <br />J[_, ~ 7[ V H; ~ MEASUREMENT <br />7L'„~5 2 ~ .~ PERMIT $~>kR#~ #R3RiyrA aax :~+F##>kt~ RP..POR" RPPONT '±lP't:/ 'Ran <br />~F/LiIE"IY GROSS VAL'Jw REQUIREMENT :T#.# 37U~ AVC OqI • r*)( Y":/ ~nY w., <br />JIL ANUgao!3' SAMPLE .. ;t4. I .74) .., .. ... ^.-ri '.`_`~'+. . <br />V I S'J A L MEASUREMENT <br />t4U;b 1 0 0 PERMIT tY•",::,".tt>•: 3c;P49T Y 55=1 r!t>~,'!Y: ......,g.~i ft?F4#Y:.~ '.-~~~ t E%. Ly '7"(',~I. <br />t:F"r LU3VT vPCSS V{Ln. REQUIREMENT I",tS? B.AL NO=O <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> e e NAOI c <br />- - ~ ~ ~ ~ ~ ~ --- - <br />-- -"--~'•' <br />°~ M <br />EA$UREMENT - <br /> PERMIT <br /> .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENMTV OF LAW THAT I HAVE PERSONALLY E%AMINED AND TELEPHONE DATE <br /> AM FA MILIM WITH 7NE INFO RMATION SUBMITTED HEREIN; AND BASED ON <br /> <br /> <br />i Mllls <br />i I <br />h <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION <br />I B0.1EVE THE SUBMITTED INFORMATION IB _ <br />~ <br />~~ ~ <br />/ <br />/ <br />3rc <br />c , <br />I AM AWARE THAT TNERE ARE <br />TRUE <br />ACCUMTE AND COMPLETE ~ <br />~ <br />/ <br />/ <br />/ <br />l , <br />. <br />SIGNIFICANT PENALTIES FOR SUBMITTING FA15E INFORMATION <br />INCLUDINO / <br />/C <br />/ <br />v O ~ na <br />i.1317d ar <br />Environmenta _ <br />, <br />ILITY OF RN <br />01 <br />I <br />P <br />N <br />E <br />T <br />EE <br />D <br />! _v _ 97{l 87{{)-c7l" l) ~ <br />n <br /> TNEPOSSIB <br />OIM <br />RISO <br />M <br />N <br />. S <br />18 U.B.Q. <br />10 <br />MI <br />3] <br />E M SIGNATURE OF PIIINCIPAL EIEECUTNE <br /> u.s.c. f tats. lPNWtlr• utsA• tMr mnrrs m.r l+cew rn.. "P ro F10,P00 AREA <br />TYPED OR PRINTED w>mvinun hwlewMti"t o/Ntwwn smmtM AMSrwa/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reieroncs sll sttschments hers/ <br />.^.T_- r ; 1..3ASE _ .. r(~.~" :1: F/r ?. Z. "~:T9C11) ~ .'.'F.r'."T7'. f.. °7"' - ~r: r~1^_ T /~ .. - . <br />u~^ ^'r •, LL" T, "n <br />-. i.'i _y FO['iP'-'1fr "/. '.'~ .:1NZT~':LV' - irF ":C'1NENi I:G :rte+rn., )e np '-~TTI+1 ql.' T. <br />EPA Form 3320.1 (08.96) Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED./ n ^ ~ ry i / ^ a r tI r -/ _ l n ~ r PAGE ~ OF <br />~_ ._ __ . <br />