Laserfiche WebLink
r <br />PERMITTEE NAME/ADDRESS (!nclude Facility Name/LocaNon ijoi$erenq <br />NAME (. r .. - ,- <br />ADDRESS o q~ t ,., • I r• .~ •• p r c <br />c <br />il~r)~ n-,Y 0.u <br />FACILITY `•T 4I J ~ ~, L?rr <br />LOCATION <br />NATIONAL POLLUTPM DISCHARGE ELIMINATION SYSTEM MPDES) FOTm Appfoved. <br />DISCHARGE MONITORING REPORT (OMR~ OMB No. 2040-0004 <br />R-161 In- 9) v T •~ ~ ~. <br />Approval expires OS31-98 <br />PERMIT NUMBER DISCHARGE NUMBER _ ~ ~ ,. ~ , w ^ ;, , <br />MONITORING PERIOD n r ° T ~• c ~ Tc' a T T• i~' A ° ~ r ~ ` `` <br />YEAR MO DAY YEAR MO DAY _ <br />FROM 90 OS D TO ~~~ ,v. >^. r.hrt' pn nr cr»v jT ^ v I i '`'.':. <br />rzo-z+) rzz-z» rza-~s),; Raz>) Razs) (soa+) NOTE: Read Instructions before gRlpleting this forth. <br /> (3 Cad Ony) QUANTITY OR LOADING (~ Cad Ony) QUANTITY OR CONCENTRATION NO. EREOUElJ SAMPLE <br />PARAMETER (46-53) (6a-6+ 3B<5) as531 (~-6+) EX of TYPE <br />(32.37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS <br />(62d3) '~'~/S <br />s4-68 <br />69-70 <br />:: Ji.i DS• "~,*sl• SAMPLE -t:±9~:F Rn,.~,; .., wr, ttC ( " %1 <br />U : '~ .`~ I. L S E ~~ MEASUREMENT <br />702 IS 1 (` 'T PERMIT gte###41' OR4P'OQ. •r b11tOIQ{,P t Rpl~ty>r~ 6 *T n±NAL TQLY .FAR <br />IFFLUc":; -c,,;- nALa; AEQUIREMENT - .r.h - t' ;~ - SVw:. o f• .,.•/t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '<r~~ --..,~ <br /> REQUIREMENT .,}~~. " <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT- <br />R `~ ~" <br />;~ti ~ <br />~"-~ ~ - - - ' ` <br />~~ <br /> REQUI <br />EMENT m~,, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~- - _ ~ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - <br />~ - <br />~ rt <br />~~`~ - <br /> REQUIREMENT ~;.;;^~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - `°~-' ~~~ - - <br /> REQUIREMENT ~ - <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY E%AMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY , <br /> <br />itichard Mllls INQUIRY OF THOSE INONIDUAlS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE <br />THE INFORMATION ' <br />~ <br />> <br /> <br /> <br />E <br />i <br />l M <br />t , <br />. <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />E ~ <br />/~ <br />r~~" "~ ~/~ ~ <br /> <br />7O'B7i)~L71L <br /> <br />7 <br /> <br />ZV <br /> <br />99 <br />anager <br />nv <br />ronmen <br />a PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING TH <br />POSSIBILT' OF FINE AND IMPRISONMEM. SEE 18 U.S.C. 41001 AND 33 U.B.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED mm3imum~pnsa na ~ b ~rwe nM~anh~i an+d 5 y a~nat up M Sto.o00 erld a OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference afl ettachmsnts here) <br />i'tT7LF.A.`%L t. .,^LI, T. I' •!.T:"~Tl ~'+)!• >I7YI'~ 'Ina D70'r.r r/or,.._-.pc r~~~T• P~ ?T• f~T' ,:r'InTurMc':T`'. `. '. , <br />~u~gSf, ;yAF+ Stn.^L` AkFiYSI`' S='~'lti''O'1 LF VISi?i.- 5'?c:F`7 Te fn~;vo•rcn~ no~nDt~r ~E~^1.7°~ ?I'i5T^(1!'TT~"~-T~'-~n <br />e <br />EPA Form 93241 (OB-95) Previous editions may not be used. (REPLACES EPA FORM 1.40 WHICH MAY NOT BE USED.) PAGE OF <br />nnn7~~ngnul2-15?9 , <br />