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PERMITTEE NAME/ADDRESS (/nc(ude Facilirr Name/Locatian ifUi$errnt) <br />NAME r.r ~ti.ir cM'.+r:.• _' rT, ft^7o~?`I(l tt <br />* "P. Q•on,. ~Ht,. <br />FACILITY C P A I `; !'? B I F 2 i <br />LOCATION <br />A;TN: A:.':JP:~ 7AJ11f •:.~. <br />WITIONAL POLLUTAM GISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (OMR~ <br />1248) p7- B) <br />^~nnn lens nne <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~'/ "I 91 TO oo nE Tn <br />(20.111 (12-23) (14251 (1627) RB-29) (3631) <br />Fonn Approved. <br />T L• 1 a OMB No. 2040-0004 <br />Approval expires 05-31-98 <br />C - PTv4• ...~.. .. <br />. -.. .-~ ...-.-:.gri~v ..... <br />• NOTE: Read Instructions befo leting this form. <br /> (3 Cdrd Ony) QUANTITY OR LOADING pCerU Onry) QUANTITY OR CONCENTRATION N0. FREOUENC SAMPLE <br />PARAMETER lafi-53) (5/-67) (38x5} p653) (Sa-sr) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> (51-53) (64-68) 6&7U <br />7?L r. %{D ;hF;,~c SAMPLE '.t r: :y.^^a ~ O11} !':Y ?r'r f: '- ..„,.,.. <br />it I:' !% n L MEASUREMENT <br />n4Jhb 1 f? ! .PERMIT D`ftLLCrP4 D ~- :_- FSel ~q'AEIE14# nlsfi+kCb PT'e`2.t I4l)A <br />~Ft•l.!JhGT "r'1c- ~l+ r ,~+ REQUIREMENT INS* K~~ qn_t) '+' • ..• " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - `:i <br />" - <br />" ~: ~, j ~`: . <br /> REQUIREMENT -`' ` <br />" <br /> SAMPLE <br /> MEASUREMENT <br /> --PERMIT <br />R <br />O ;:~° ' <br />~" <br />~ <br />- _ <br />''~~ ~ ~,+ ~'~4'• - <br />° <br /> E <br />UIREMENT ~:, <br />. <br />_ _ _ <br />,.~, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -.=, -;'-",.- - '`" <br /> REQUIREMENT '~;.; -%" - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> " PERMIT ~ <br />~' " <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> --PERMIT <br />- nryt;=~ ~- <br />i" <br />' <br />~r - ~- <br /> REQUIREMEN7 ~ <br />, <br />}, <br />-,. - <br />' <br />NAME?ITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />N <br />F <br />M LAW THAT I HAVE PERSO <br />T <br />IT <br />D <br />ER NALLY EXAMINED AND <br />IN' <br />AN <br />BA <br />E <br />ON MY TELEPHONE DATE <br />Richard Mills AM FA <br />IILIPA WITH THE IN <br />OR <br />INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION, I BELIEV ION SUBM <br />TE <br />A <br />H <br />E <br />S IMMEDIATELY RESPON <br />E THE SUBMITTED IN , <br />D <br />S <br />D <br />SIBIE FOR OBTAINING <br />FORMATION IS TRUE, ~ <br />/ <br />` <br />~ <br />~'( <br />Environmental Polanager PE <br />M <br />A <br />CO AF <br />TI <br />6 T <br />S / <br />~ ~~~ / <br />~ <br />t <br />~ 7~-87Q-Z7 t'•C 7 Z$ 9g <br /> NCLUDING <br />AE <br />NAL <br />TIES <br />FDR <br />SUBMITTING <br />ALS <br />INFORMA <br />ON <br />POSSIBILT' OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S C. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED merimumlimnns+onmenr olb•hseen~6 months ~5u0o Imes up ro ft0,000 ATM or <br />P re•mJ OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell attachments here) <br />'L:;.. LI"Ii !pn(..pr +•n ,vnl•;rn F•Lr'V cRnw n'llr U~; s- 9."l. 9T( o Cvv.~r• r,~a -.r- r ~'r~ ^ri+lroc+ *r <br />YISItlL.`: rS9E-'N i5 1~`;°~/,.^. ^H*PLY iAKeLIp; Il:~rceir*I~NS'I•~•R. ^~ •• - <br />°_PA Form 33261 (08-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF <br />