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FERMIT'TEE NAME/ADDRESS Odd rraro.v~/c«nla, yDrab.vj <br />NAME <br />v l n L [. ~. :. ~ :. ... <br />ADDRESS r, ~ ~ i ,. :.~ ~~ I •: I <br />i'..i. r Y j(1. . <br />~i,.I:viA <br />FACILITY <br />n_ l.i ~; ... .:r. <br />LOCATION <br />~. <br />.. .. : , . <br />NAT1oNDISCHARGE MON TORINO REPORT % MRIPOESI <br />17-161 17-I91 <br />` PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM . / i „ ,. i TO -17 , , <br />!76711 l77-131 !14751 !76771 l76-791 1303/1 <br />Form Approved. <br />r' I `~ f. i : ; "' ^ _ ~ V OMB.No- 2040-0004 <br />- App"rove elCplra~05-31-98 <br />J' - . „ -. <br />..?., <br />NOTE: Raed imtructlaa Mtori FompMtlnp this form. <br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING !1 Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> 1653 151611 l38J51 4653 !61-61 X OF TYPE <br />137-371 E MALY519 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l11-6]1 /64681 (6¢70/ <br /> SAMPLE <br />~ ~ ~ <br />~~ <br />~~ <br /> MEASUREMENT <br />4 7 <br />'. ;l <br />ii <br />. <br />. <br />t4J~b 1 G •i PERMIT ;., ;: : `.i^cT Y <br />~ <br />~ . ,-? <br />- .. `Y<;:>'f trt,:;:;.y::: s:-~'~S.k"~ <br />:...:. "FiK?.Y iLSI1kt <br /> REQUIREMENT .. <br />•~ ~~ ~ : ,-.1 ,.. v , <br />, r <br />( -ii ti. <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ~ ~ , ! i ~ ~. <br /> ~. ~ PERMIT ~ ~ ~ ~~ ~~ <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TRLE PRINCIPAL EXECUi1VE OFFICER I cean <br />AM FA FY UNDER PENALTr of <br />MIUM WITH THE INFO uw TNAT I NAVE PERSONALLr EkAMINED MD <br />RMATION SUBMITTED HEREIN; MD BASED ON ~ <br />: TELEPHONE GATE <br /> DIVIDUALS <br />MMEDIATE <br />Y RESPONSIB <br />E FOR <br />RY <br />OSE / <br />/ <br />I ~ ~ , 1 <br />' ~L 1( MY INQUI <br />OF /H <br />IN <br />I <br />L <br />L <br />OBTAINING THE INFORMATON. 1 BELIEVE THE SUBMITTED INFOIMATION 19 <br />, TRUE. ACCURATE AND COM0.ETE. I AM AWME THAT THERE ME <br />SIONINCM7 PENALTES FOR SUBMITTING FAL9E INFORMATION <br />INCLUDING ~ ~~-. <br /> <br />' <br />~ , <br />ITV <br />M%IISON <br />SEE <br />C <br />E <br />001 MD 3 <br />T <br />R <br />E M <br />ENT <br />U <br />9 <br />r _ <br />' I <br />~ <br />l <br />~ <br />, ~'' I I <br />i 1 ~'. . <br />HE P059BIL <br />OF <br />N <br />O I <br />M <br />. <br />1B <br />. <br />. <br />1 <br />3 SIGNATURE OF RIINCIPAL EXECI7TIVE ~ I ~~ <br />I ' ~ ~ <br />/ <br /> <br />TYPED OR PRWTED U.9.C. 7 1318. 1/V1YR/r1 IIY/II dMa /hIl/roI nrY IMA~lF rYM~ .q ro E/0,000 <br />wwnruirx.ni,wrsimMrn erNrwrw lmoiNrAx's N.vs/ <br />OFFICER OR AUTHORIZED AGEM <br />rA,ODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA /Ions lrrlrerence Ni srrscnmenrs nlrel <br />,- ~r ro ~_ .~~ -- r. r.. r. <br />- ~ T <br />EPA Form 3320-7 8-851 PravioUs editions Yn'ey'tie uded. ^' /REP CES'EPA FORM T40 WHICH MAYNOT BE USED. ~ _ + PgGE ,OF <br />