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PERMITTEE NAME/ADDRESS (LrL4 f,rreryNaWlaanr l/Dr~irrrl <br />NAME t <br />I <br />ADDRESS r <br />FACILITY `1. ,; ., . <br />~1 I. :11.i L .I .~ ~i ~.v <br />NATIONAL POLLUTMT DISCHMOE ELIMINATON SYSTEM NPDESf FOnn AppfOVad. <br />DRiCHARGE MONITORING REPORT r0 R/ 0 B No. 2 40 0004 <br />1-l91 I7-191 ~ „ I T ,. M Q-- <br />i ' Adp~ovdl bkplree 05-31-98 <br />PERMIT UMBER DISCNMOE NUMBET ~ ~ n 1 ` _ -.. <br />r - i L :h._ <br />MONITORING PERIOD '-~ +' ~ ~ n. <br />YEAR MO DAY YEAR MO DAY <br />FROM i :; d., .! TO - ~ y .: ~ ~ r. .k r ~ c ~. ,. . <br />110-111 !11431 11b261 126-I71 /38-291 134911 •, NOTE: ~{..e ~netruetlar bP one pletlnp thb form. <br />PARAMETER 13 6rd OnlYl QUANTITY OR LOADING is and o~lp QUANTITY OR CONCENTRATION Np, FREDUENC SAMPLE <br /> !»o-a'3' 'o'-'.-s;' '-~p"'~' ''~`~'3' •'~''~;' <br />(31.37) EX MALVSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS na-sal !s~-sel 169.701 <br />.. ~ ~-v,1y SAMPLE {•:•{•{a ;.Y 1 d <br /> MEASUREMENT <br />~ ~ i y <br />I <br /> <br /> <br />.. ' l U J <br /> <br /> <br />::.: .:.: <br />..:::..:...:: <br />., .. MI .::: <br />':. ~. <br /> <br />: <br />' <br />' <br />.. <br />i <br />~ <br />~ <br /> <br />~ <br />~ <br />' <br /> <br /> <br />l~ <br /> <br />~ <br />~Y <br />/R~7 <br /> <br />_ . <br />^ <br />Y <br />5 <br />' <br />U <br />~ <br /> <br />' <br />~ <br />L <br />~ <br />~ <br /> <br />~ <br /> <br /> <br />l <br />~ <br /> . <br />. <br />: <br />RE <br />U <br />E <br />lEN .. i~ <br />.V <br />.A: <br />.F <br />., <br />.? ..;i <br />..i <br />.l .. a~ <br />.: < .T <br />:T <br />.. <br />.::i~.: 4 <br />. <br />a <br />. <br />: <br />.::.:'xV~:. kJJ <br />i~ <br />1: <br />i;.a'.'i <br />.. <br />i. ' •14~: (.'.::: ; <br />ii.iu <br />. <br />`.. .. /`t , <br />Q <br />~9 <br />y <br />T i 3 Y.~:~ ~ ~ xt aE ': 'a u•' <br />u:a t Li <br />:, .-~ , - ~E i ~~ I :.~ `SAMPLE :. ,: #t#{. 4y1 .. ~.:.•. {•444ith <br />~> <br /> MEASUREMENT <br /> <br />. t, , . . ~ '; u >;: PERMIT..: <!' ?tar''r+Jx~~!: i; ^'';r~'yp,t,~a: v ,.:: >r 'WM'4€ay' ::: <br />~ ...,.... r H .iT ~.iPT:I'w1;,~:~1 <br />: ~ ~t-~ f ~ ~"As: ' <br /> <br /> <br />r f <br />/l REQUIREMENT. ,.,. <br />,. <br />~ . .. <br />: <br />.. <br />... ,gin f~a:;.. <br />~ ~, I <br />. , r r N ., L_~14.)lJ I SAMPLE J ti<;, >... .{< <br />;, i• 'ti<{<. . <br />incpTM~Ei.~ _„ <br />~ MEASUREMENT <br />,._ .~ i, O' <br />~ :~... PE:RMI7~ti ..~':' <br />H ;.;'1 ~ .:T <br />" <br />F <br />'P.t1~' <br />~ <br />' :zs~M+afi •k <br />~~ <br />,... <br />i*~k 4~*y;`'.. ~{.'i?li!ffi~>j ~a f'~Y <br />~ ~ <br />t <br />ll F i .REQUI <br />EMEPC6:L <br />- .::; <br />. r <br />~-i': .. <br />~.. <br />ri -:.:,: .::: V .;,;,< <br />' SAMPL <br /> MEASURE,. NT <br /> <br /> iF3 NT <br /> PLE <br />_ MEASUREMENT <br />~ ~:~..'PERMIT '' ~~~ <br />~ <br /> ~REOUIREMENT~. ~~ "~ <br />qtr SAMPLE <br />~rn <br />~ MEASUREMENT <br /> ~ PERMIT <br />-,'': <br />.~~ ~ ~~ -~ .: <br />:. :.. :::. ... ...: .:.. <br /> <br />:: x;... ~.., <br /> <br /> <br />:, <br />" <br /> <br /> <br />~ <br /> <br />~ REQUIREMEN•T~ - ... ::..~; .. ...r... , . ~.. :.: ~ ~ <br />~ ... <br /> SAMPLE <br />~ MEASUREMENT <br />~ <br /> PERMIT' .. . .: <br />..: <br />, ... .... .. <br /> REQUIREM..ENT:. '' <br />,.. <br />, <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTFV UNDER PENALTY OF L <br />AM FAMILIM WITH THE INFOR AW THAT I HAVE PERSO <br />MATION SUBM <br />TTED NALLY E%AMINED MD TELEPHONE DATE <br /> <br />MY INQUIRY OF THOSE IN I <br />NEREIN; MD eMED ON <br />DIVIDUAl9 IMMEDIATELY RESPONSIBLE FOR <br />a <br />~~•. <br />'-~ <br />'•C <br />" <br />III i OBTNNINO THE INFORMATION <br />TRUE <br />ACCUMTE MD COM , I BELIEVE THE SUBMITTED INFORMATION IS <br />P <br />ETE ~ _ ~ <br />' <br />c <br />1 <br />; <br />. , <br />SIONIFICMT PENALTIES FOR S L <br />. I AM AWME THAT THERE MF <br />UBMITTING FALSE INFORMATION <br />INCLWINO ~ / <br />- I '' <br />~~ - ' ~ <br />.IC:n.:':Pil~.)1 ., .J .".f'. :Y THEP099BILITY OF RNE MDI , <br />MPNSONMENT. SEEIBU.B.C.11001 MD7a _ <br />' ~ '~ ~- - <br />fIONATl <br />RE <br />F <br />P ~~~ v~; ~-%r~ ~ ~ [):; <br /> <br />TYPED OR PRINTED U.S.C. E 1913. fhrltl„ utlr LMr ,bruN, m,r NkcAN, Br+ w ro r rD,000 <br />H 1 <br />O <br />PRINCI <br />AL EXECUTNE <br />A A <br /> <br />__.-.._-.__ ..._..._. .-.. _._-. _. ...,, ... _. .as nm,r <br />x,n Nwfswrwrte/an..m t mane!, rtl s rr.a1 <br />._._.._ ._ OFFICER OR AUTHORIZED AOEM <br />CODE HUMBER YEAR MO DAY <br />...,.rmn~~n ,.a nnv ~nr ~nnn ~ wn v. nn. •w~n nvna rnr. rimer n. ruaannrns nr.r/ <br />I:,r~l,:...r ,Ar~~L~ ,;~~~) _ L..1.~_~1.,_, ~...!Y~~., .. r'„ ...t~ r .__,. ~., ,.,, <br />EPA Form 3320-1 108-961 Prsviou3 edition3 mey be uesd. (REPLACES EPA FORM T~0 WHICH MAY NOT BE U6ED.) PAGE OF <br />