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PERMITfEE NAME/ADDRESS p~6FNgNa/L«ulm dD~fsno) <br />NAME <br />G :JN~ '. .. r' ~ ., <br />o~ <br />~ i`•ii• JA t i' „ <br />FACILITY i~ ~{ ~J S : A _ ~' ~ li) -i <br />LOCATION <br />I I . P is <br />NATIONAL POLLUTMT OISLHMOE EIJMINATON SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT (OMRI <br />Z-16 /7-19 <br />r~1 1' 1,. ~.5 'i1l L <br />PERMIT NUMBER DISCHMOE NUMBEA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM '. ~ ; ~ .~ j TO ~?'] 1 .! i 1 <br />1161/1 nb131 r14I61 na~n na-2or l3nsn <br />Form Approved. <br />1, ~, ` : ~ : :..; .:, , _. oryR~ Nol {04o-oooa;~ <br />a ~ Approved exyirse b5=31-98 <br />C i TI .11?. <br />NOTE: Reed Irutruetlarr befen eomPleUna thb fam. <br />PARAMETER !3 Grd only! QUANTITY OR LOADING !1 GTd Onhl QUANTITY OR CONCENTRATION NO FREQUENer SAMPLE <br />!91371 !1653 !5461 /38-451 !<663 5L6I OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX <br />N3-6s! MN.rss <br />161.551 TYPE <br />!63701 <br />.. ~ c <br />~, .L :. 3 !! i+ - 4 > ° SAMPLE <br />-... <br />( : U ~ <br />.. :. :. ... .. .:... ,. .. ,.. ,... <br />~ . <br /> MEASUREMENT <br />~ L.; ii. <br />:u~!-~ i U ~ ..PERMIT ~ 1'_~::~~.^s es f: .:~: F. ?{7 ~i'. ~ i:':- <br />-1 .,.'_a~: s2: ~ <br />G's+^,3v ~ <br />4:r,,.Y ,s y:g .. <br />?.'~ <br />Eli <br />;.T. U 4f <br /> REQUIREMENT ~ . <br />cw -tin dt .T Y'S~ wS'i n~o(1 <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~~~ PERMIT~~~ .. .. ,. .. . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT l1 /~ ` <br /> <br />/ / <br />~ r ~ - C <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 />NAMElTITLE PRINCIPAL EXECUTME OFFICER I cERnFr uxom PENUrr of LAw TNAT I NAVE PERSO <br />AM FAMILIM WITN THE INFORMATION SUBMITTED H NALLY EXAMINED MD <br />EREIN <br />MD BASED ON / TELEPHONE DATE <br /> <br />); <br />L <br />~ A <br />!' : <br />MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR / <br />:- <br />' <br />r <br />I <br />! <br />' I OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ <br />y/ <br />/ TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFCMT PENAVIE9 FOR SVBMIT7ING FALSE INFOAMATION <br />INCLUDING <br />' ~ ~:~, ~~,~ v <br />J / <br />/ I <br />- , U !' /I I , <br />r <br />THE POSSIOILITY OF RNE MO IMPWSONMENT <br />SEE 18 U <br />S <br />C <br />! 1001 MD 33 J~Q - <br />~ ~ ~ / ~ <br />. . <br />. <br />. <br />. <br />u <br />C <br />E t]1e <br />lArrsY. wtE•r tMr mroN. rrlr <br />S <br />6r. <br />h <br />4N <br />J 10 <br />000 BIONATURE OF PRINCIPAL EXEOUTRlE i1 / <br />r <br />i ~ . ' <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />e <br />i <br />1P ro <br />, <br />r <br />i <br />i <br />Y <br /> Ans n.rr. <br />rlun <br />rplrwrwrr o <br />A•nrrn smmN.W6rria/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />a.vmmaY ro nn~ cnrcnnn nvn yr nn. rwcn ~ wn.~ rnnoenc~ en suscnnrsn~a nero/ - <br />-~, !'. ~l..ir -. .. :il'.1 .. (' ~i L. ,'11.f .-i ~~Y ~.r 1.i._ o ~. .. - ...T - -I 14 .1 ~ ~ . <br />~T• _ ~ <br />EPA Form 3320-7 8- I PreVioue ediGoriti rntiY tie used. - ' ' ~ -/REPLACES--EPA FO$M Td0 WHICH MAYNOT BE USED.1 ~ _ 1 PAGE ~ OF <br />