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PERMITTEE NAME/ADDRESS pki,Af.NIryNaWLorno. IJD~i.aO
<br />NAME C Y ° . -! - .~ .. -
<br />ADDRESS ~ I ~ ~~ 7 i r 7 : ~ :{ -I n ... ~ ,.. .
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHMGE ELIMINATION SYSTEM (NPDfSI
<br />.. „ I ,~ A DLsCHARGE MONITORING REPORT (OMR)
<br />!I- f el 17-191
<br />:4 ,4 `: D! ;:17(1271J'~ fin-/ A
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />~1 y , I T ' MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 4 ! U .~ TO `t" ~• X11
<br />A L ? ^ "1 -( I1PI1/ l11-131 !14151 /16171 !18.19/ !36311
<br />Form Approved.
<br />.. ..; -,:,.~,, ~.. ..-,OIdStNo~2040-000A .-K
<br />(_I,. .,, ;,,,) Approval e~lpti rPs 05-31-98
<br />_ ~ • 37!,
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<br />NOTE: Read Inetrucdone be}of eo latinp this form.
<br />PARAMETER 13 GrC OnlYl QUANTTY OR LOADING !4 GN OnlYl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE
<br /> !<5-53I !54511 l38-451 !<6-531 1545/1 EX KV E
<br />l31-371 SIB
<br />AN TYP
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS rs1-s]1 !54581 169-701
<br />i '~'.'~r P:~:PAL SAMPLE ;:~#:: .-~~::# S"~-sir-t I 1_•7)
<br />(',~ rF) MEASUREMENT
<br />J1CU7 J p PERMIT ##R##X. 'r ti#v#3 #'k Srk#rt!:# RrO1pT narnr,.I• M^_£/ :P.AN
<br />ii CJ`I ~: ^:N?'S rL:L7A REQUIREMENT #~!
<br />Y 300A 11Y/: LtPT IY NY Y'/L A!1NT'{
<br />"~~~~, In--TAI. SAMPLE .`•~"s +^*r~ #4##fi:t ###r3r"`
<br />( 19)
<br />(:,~ Vic) MEASUREMENT
<br />;1(145 1 0 0 PERMIT #;ka`-#rE' #'.`•::{=v`t: ^:# X~"!rX,e#-Y 3,S 7en t ~~,^¢;/ -P.A?
<br />:'1':.U"~.C ~ROS$ YAI.IIF' .REQUIREMEN7 #IFR# 3•'1P1 IIYC O~TL? MF. '1r•,/L t*ONT4
<br />..JJ~ f.N CJNOUIP UP SAMPLE ( )3) ,art^. a~ha~:+(::` ':fl:`, ,
<br />,i ~~U T~`:A C!!P,YT PLA°, MEASUREMENT
<br />.iL50 1 0 C) PERMIT H£nOR7 ~ SAPEQNAL xr~r,<nr,-ts `^'~'•'~`:`- #'`•~C';`t:p ~~ rxlrLy 'v'TA':
<br />'fYLU F:'1T Gk'Ji; 'lRLrc REQUIREMENT 3c1pA AY, ~ DAl;Li :if.Z 9'.7 '-'~"''
<br />:IL P.N~ =.RfP i' SAMPLE .: Rt,. ( la) {-t::~.. . .:,~~;...:. ,:.~rYl:>r..
<br />ti I -UAL MEASUREMENT
<br />!'l~(,b i 0 ~ PERMIT 4:Ot'`:r,."r 7 Y G,r_I 'I«::V=: f,: '- r i_":t :t:k «,+~.«. Fd rl .. •T^i1E.
<br />:fl Lll E'"i ?' ,r^~5 ',A*., ']= REQUIREMENT ~~ I!!~T '4 P.$ NCJ=O ~,
<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 E%ECUTR/E OFFICER I CERT
<br />AM FA FY UNDER PENALTY OF UW THAT I HAVE PERSONALLY EXAMINED AND
<br />MILIM WITN THE INFORMATON SUBMITTED NEREIN; MD BASED ON
<br />,. TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />Richard Mills OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS
<br />
<br />4
<br />l ~
<br />i TRUE. ALLUMTE AND COMPLETE. I AM AWME THAT TNERE ME
<br />SIGNIFICMT PENN TIES FOP SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />12
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<br />7
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<br />anager
<br />Env
<br />ronmenta , 0 -
<br />7 37 98
<br /> THE POSSIBILITY OF FNE MD IMP11150NMENT. SEE IB U.S.C. 1 1001 MD ]] 610NATURE OF PRINCIPAL E%ECUTRJE
<br /> U.S.L. E t ]te. lA,rrV„ udr N,,, mNh, .n,Y hcA~d, !n„ y ro t 10,000
<br />' AREA
<br />TYPED OR PRINTED wwmuine.n irlpn
<br />aa'wwnrWMfwwn smonre,.nes Y..r.l OFFICER OR AUTHORU:ED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS lReJe/ante e!/ sftechmenls he/el
<br />i !?RNATc, ?-Lv ll_;, Pr1; '!'~ , i~iJV ° ~:il'I,°~ ' C° „r F•~T• -•lIy :c i- ~1 (`_`•+r ~.1_y`.. p '~.;' ~'4
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<br />Epp Form 3320.1 106-961 Previous editions may be used. IREPlACE6 EPA FORM T-40 WHICH MAY NOT BE U6ED.) „ "r " I~ / ~ n !, Il ,~ ~_ T n. t „ PAGE _ OF
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