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PERMITTEE NAME/ADDRESSO~bfswryN.wlocmlu.UDlp..w <br />NAME ,+ + .. L `. . , - T * . ; I <br />ADDRESS - ,1. I - . ~~. ~ .. _ ., <br />. .. ~' <br />r .; . <br />FACILITY , i . -~ _ _ ..: ti ... <br />LOCATION <br />a . <br />NATIONAL PDLLl1TMT DISLNMOE ELIMINATION SYSTEM lNFDE.i/ <br />DISCHARGE MONITORING REPORT /DMRI <br />!2-151 l17-I91 <br />PERMIT NUMBER DISCNMGE NUMBER <br />~ ~ MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM -1 ; 1 .^. 7 TO +: 7 ` % ~ <br />i'~ l70Z11 l77-Y31 /14251 !26771 l75-791 130-311 <br />:...... a ~, ..,ed. <br />n;-, ~. c ; T-• .t ,, , p r r 7 OMB No'2040-0004 <br />- Approval expir~ p 05-3i-88 <br />(° -. ~) ~ P <br />1 ... . <br />NOTE: Reed inetruotlaM fLefore compNtinp 1hN form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Cerd Only) QUANTITY OR CONCENTRATION NO FREOUENCT SAMPLE <br />IJ <br />371 /16531 /5461 l35-461 !4653 1646/ OF <br />2 EX YSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-5]I ANAL <br />(54661 lG4701 <br />It '>-~ 1Y SAMPLE ..... - ., .r..:. <br />~ <br />! I) <br /> MEASUREMENT ~ <br />'.i ~1~ C R PERMIT ... .{; •".1'G' r,:;:!f',<C:'7 <br />~ ~ <br />~~ .: <.:; r`:'i,: ?.' <br />1 Ir'~o <br />.i»'~ / <br />~:J t?;' ~..i <br />. REQUIREMENT , <br />,, _ " . <br />t L.+E i i ::DSDCI I SAMPLE <br />MEASUREMENT /~,~ <br />~ <br />`~ ( n31 ... I <br />,~ C~ -: N "' I` (, r. ~ . <br />. . ~~~^~ ~7 • U O T» <br />^ ! <br />~,;,•L; <br />1 G 0 PERMIr <br />~ x.(! <br />1'3 <br />5 ?r.Pnpr y:x,:Ji~>Ff.., a^=:~e~:~t~ ~x;fs,xr;,~.. .; ,. z <br />~.I= <br />.a: :sl=,"n•: <br />~ ~REOUIREMENT . <br />. ~ ~ ~ . <br />_ <br />. <br />Y' ~ 1 ;I : 'J '^ L1CS a I1 ~ n R. M _; ~~ . <br />.~ <br />1t <br />-: ,J ,.. r~Ll If .~ F t "CAL SAMPLE <br />:.:.: <br />.. <br />... .. <br />. , , <br />( 31 <br />~ <br /> <br /> <br />..: -. is A L <br />MEASUREMENT <br />~ .w <br />j <br />~ <br />i <br />V : <br /> <br />~'n <br /> <br />~~ N ~ <br />7 v'..~J 1 Q ~ PERMIT .:~t:zY,r ~: r,:':c:'s l:x: :'."- t^.r\') <br />.. ~iG°tu ~ / 1 @Cr~ 't1i <br /> REQUIREMENT <br />c . ~ +~ c' ' r V a I - ~ r~ -~ : n .% .. I a " t• _. 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PEAMIT <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/TRLE PRINCIPAL EXECUTNE OFFICER I CEADFY UNDER PENALTY OF LAW THAT I NAVE PERSO <br />AM FAMIUM WITH THE INFORMATION SUBMITTED H NALLY EXAMINED AND <br />EREIN <br />MD BASED TELEPHONE DATE <br /> <br />jj <br />/~ :!!1 ..I'-7/C~/. ; <br />ON <br />MY INOUBTY OF THOSE INpINDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE. ACLUMTE MD COMPLETE. I AM AWME THAT THERE ME .' <br /> SIONIFICMT PENALTIES FOP SUBMITTING FALSE lNFORMA710N <br />INCLUDING ~ <br /> <br />~~~~ , I/!, -~ , <br />THE P059MLITY OF RNE AND IMPRISONMENT. SEE 1B U.S.L. ! 1001 MD 33 ~ _ <br />~ <br />~ <br />SIGNATURE OF PRIN <br />P <br />."- „~ <br />- - -,~ <br />~ <br />~ / <br />~ , <br />T- <br /> u.S.L. ! 131e. lPFrW1A. ~nWr Urs mem. nMY hrhW rrra .p ro E IO,Or10 CI <br />AL EXECl7TIVE AREA <br />TYPED OR PRINTED n10nm.tYnun irlAr4annrn alarrwAn Smane5a rM5 ywrs/ OFFlCEq OR AUTHORIZED AGENT LODE NUMBER YEAR MO DAY <br />..vmmo.I a nnv cnr cnnm rvn ..r nn. ..vc.+nvna rneiwsnce su suscnnrnnm nenq <br />.EPA Form 3320.7 (08.86) Pralioue sditione may be used. IREPLACE6 EPA FORM T-40 WNICN MAY NOT 8E USED.) 1 / .-.7 ` 1 _ i , .I t PAGE i OF <br />