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PERMITTEE NAME/ADDRESS (twdlLF.clhryNaw/laanm dDlg..n10 <br />NAME I, Y,o :~: :. _ ~r .,.-y.. <br />ADDRESS ~I 1, _ .i .I , ., ~ ~ .~ F ~ t. ! A `: <br />ti ~ Eire ... .. . ,.^. ]g155 <br />FACILITY ' <br />LOCATION <br />.'~'!'~"tJ: nJ../Ic '..•.-T.'Y~ ..~'~L}:a4I, .IptiY <br />NATIONAL POLLUTMT DISCNMOE EIIMINATON SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT (OMR) <br />11-161 I7-19I <br />-]r,..~271~1 Cpl ~ <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM i i TO `I H 1 <br />!26211 112-131 124251 116-271 l18-291 !36311 <br />Form Approved. <br />'+ ~ - ? ~ r..~ ~ ~ m nOMBtNoa 2Q40-0004- •- <br />(,-„r„ I, ..) Approve) e~pi[ee 05-31-98 <br />o _ c r E . <br />.,,,,- <br />NOTE: Raad Inetructime bslore complatinp thie form. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !4 Grd On/yl QUANTITY OR CONCENTRATION NQ FREOVENCT SAMPLE <br /> !46531 154-6/I 13851 !16.53 I50-611 GF <br />I31-371 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX <br /> <br />I(2-6J1 <br />MALrsls <br />(64681 TYPE <br /> <br />169-701 <br />r. )M~ T. ~) .4L <br />r <br />. <br />• n SAMPLE <br />MEASUREMENT :: 5; :': :: ;t :t ;: ~I :k .«., r.#...; ,.... <br />~• ~ ~ <br />~ <br />4 ~' ( 7U~ <br />~ ~/ <br />3 ( <br />C,/ <br />6 <br />( <br />, <br />; I, <br />I • q <br />~:.JUS j I1 1 PERMIT r:3krS"~F !kRLrG#;~ <br />, - .. ,tYw«~f ~.5 T.7 I ''I~EJ ;f'.4° <br />d[~LUE?1P SR1c' 9P,LUc REQUIREMENT '-.+>l::.¢ 3!TCA FCG nkTLT PY "C/:. '"') ~u <br />!'L:7N~ .TN C'J4f; :IST, OR SAMPLE y ( J3) O##r#.; s.;,,ti..-.~.. .;ail:': {s :: ~( y <br />/ <br />L[!:t'1 THr:4TMF"r PLAR MEASUREMENT ~, (7Z3 0. 03 `/# {(J 3~ 'l~sr <br />;lJ`15O 7- 'I J PERMIT RRP03i ^PTIOYI4L rv'.-~~ztt #t<##t>fi •sr'.tdt':t2: I #r,;.- $oe.f,Y :!i5^'A'i <br />P;'LJf!J'^ ~';'~; YALOF .REQUIREMENT 3DP,4 AV.; p.4LLY ?!X ~!C'. #:`-",': <br />,T(. AND ~R:;AS% <br />' <br />~ SAMPLE <br />MEASUREMENT ..~¢.:` <br />~ ( 9'l) ,::#"~`..: .,vim«*.. r#^:: .'~ / <br />~/ <br />1 <br />" <br />_ <br />~ T <br />U A L 3/ i <br />1 S <br />- <br />.411hf: 1 ~ 0. 0 PERMIT G':Gr;:t .. 7 T ES=j Srt~mr^: ;~'; :kr,. n:~ ^:~ ..tti <br />i`L'JENT 6RDS5 V~'.'1'- REQUIREMENT ;Y!3~r MAX NQ=O ~'': `fi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT:':::~1-2 . <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 EXECUTIVE OFFICER I cERTI <br />AM FA Fy UNDER PENUTr of tww TNAT I NAVE PERSONALLr ExAMINED MD <br />MIUM WITH THE INFORMATION SUBMITTED NEREIN <br />MD BASED ON TELEPHONE DATE <br /> <br />I ff ; <br />MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION <br />I eEUEVE THE SUBMITTED INFORMATON IB <br />~ <br />l: icfarc~ I "IIIs , <br />TRUE <br />ACCUMTE MD COMPLETE <br />I AM AWME TNAT THERE ME <br />/ <br /> , <br />. <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ ' ~~ ~~ <br />~" ' <br />~milronme~tal •~lRi'd~TPI' , <br />TNEPOSSIBILITYOFFlNEMDIMP/1150NMENT. SEEIBU.S.C.11001M03G <br />U <br />S <br />C <br />E 1 ]1 e <br />lP ~ <br />SIGNATURE OF PRINCIPAL EXECUrrvE <br />9 ~ D 1 <br />e ~ o- _ ~ i z ~~ ZO E;R <br />. <br /> . <br />. <br />. <br />. <br />wWl.. Mw e.,r .soma mFy L,raa. Fem. w ro J 10,000 AREA <br />TYPED OR PRINTED rWnnrrrirlsn irw'isml.Ttb NMwT Snlans. rW6ywa.l OFFICER OR AUTXORIZED AGENT <br />CODE NUMBER YEAR MO DAV <br />GVMM[n I O /1rvY cnrlnnn I wn yr nn r vlvln I IvnJ Inert/voce s/I srlscnmmli ne/9/ <br />4LT56NAT`: LI~I"i fCr. - "Pi 'r^ `'S 4' - T~ ( r t _ _ - <br />.'~~ ..:L L~" ~C ,:1''~ L^~^ l ) In~TP 1J~•~ rc !- +n_v:,~ ~:I_ ~~ ••p rt,_ -r~_. <br />CLAI~r:U.. 9FR T.A.I• `• j".F '')h ~'RDr9 1r P{J')v i°^'1TprMpaTr•~ nrr, ^onF.;c_~ ;n r•1mr r~ .. <br />l'>Pfli Y J ePI TN C nnDn']TT U^ TVCP9'1 ^rr(lvv_c ~n vN nm~• n• <br />EPA Fwm 3320-T 108-951 PrevlOUe edlbone mey ba Deed. (REPLACER EPA FORM T<0 WHICH MAY HOT BE USED.) PgGE OF <br />