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PERMITTEE NAME/ADDRESS (Include Faciliry Name/Lpcarisn ifhifferent) <br />NAME <br />ADDRESS -•A ; [. F ^, T •: ^ "1 " ^ • ='r <br />FACILITY C II '~ ` ` ~ D 91 6 z 5 <br />LOCATION <br />?TTNt A;~:6 F1'"' 9e`re- v_r_ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDFSI Form Approved. <br />DISCHARGE MONITORING REPORT (OMR~ OMB No. 2040-0004 <br />R-+el pr- a1 -• - " ^~ ~ Approval expires 05.31-90 <br />..~n~~nTn nn-s f-~~). c rg~ <br />PERMIT NUMBER DISCHARGE NUMBER -, - r ~ „ ~ ~ - ~ „ , <br />MONITORING PERIOD '~ ~ ° " T " ~' S ?r, V T I. L T ~ ~ ~ "" ~" <br />YEAR MO DAY: YEAR MO DAY <br />FROM 9 71t 0 TO ~ ~. n.: T~n l.rrt ~0 n. °C'f ~~ ;c ~ ) ;: ~.x <br />czo-• >< rzxs31 24-z51 (z~zn rzs ze( t~7U NO¢': Read Instructions belorel pleting this form. <br /> (3 Card Ony) OUANTII'Y Ofl LOADI (4 Card OnyJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46.53) 54-61J (3815) (46-53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM ~fITS MINIMUM AVERAGE MAXIMUM UNITS <br />(62471 ~~~ls <br />61-6BI <br />69-7U <br />.Il. ~..4 _i,FA"' SAMPLE aR ( '1.11 rn.:-^'t+t <br />y j; ~ (, L MEASUREMENT <br /> <br />'CUhh l f: D <br />.PERMIT- <br />"914~auo <br />Cl ~~ <br />F'^.j <br />'s )1tRt1Jt <br />11Y1FIOty+~RS# <br />'x3$a1t4 <br />"" <br />~ <br />" <br />~Q~'~ p <br />~r5ir~l:- <br />FE'FLUP:h C ~:.P~S`' YA! r.= REQUIREMENT - INSS tfL ' `IJ=O ,'~ =` ~ ~' '`°;~'` <br />~r;. - ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~- nx?K~Y <br /> REQUIREMENT ~;~. ~ ~ .~,~ y. ~.` ' <br /> SAMPLE <br /> MEASUREMENT <br /> ~-:-PERMIT <br />. <br />"' <br />.. ^~ ~,. - <br /> 'REQUIREMENT , <br />`~ - ~`' :. - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br />.x, ~ ~•~- <br /> REQUIREMENT * _=- <br /> SAMPLE <br /> MEASUREMENT <br /> -PERMIT <br />- ~' ~ a~ <br />~ ~ _ <br />A ~' ~` <br /> REQUIREMENT - .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br />~ "` <br />- <br /> REQUIREMENT - .. y'~-;:;1 d .~:- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ . .. ,~ :. . <br /> REQUIREMENT -. _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV <br /> <br />h <br />d Mfll <br />Ri INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE <br />THE INFORMATION <br />~ <br />/ <br />/~ <br />ar <br />s <br />c , <br />, <br />THAT THERE ARE SIGNIFICANT <br />T <br />M <br />AM AWAR ~' <br />1 <br /> E AND CO <br />PLETE. I <br />ACCURA <br />E 970-B70-2712 7 28 99 <br />Environmental Manager PENALTIES FOR SUBMITPNG FALSE INFORMATION, INCLUDING THE „t, . , <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. SIG1fATURE OF PRINCIPAL EXECUTIVE <br /> u~?irres up m E1D,e6o Arid or <br />~ <br />e <br />~ <br />m <br />~ <br />§ <br />B pFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED nd 5 <br />mon <br />art/u <br />mevmum <br />pds <br />ol6enree <br />B m <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence e/l attachments here) <br />~.,..I L:: A'IL, ;'1L"~t: l.r.,:: i'IJr? rnr )Iflf P~zlipn r,r~•J. r"'°- 7. A.. 7~ u' •r ^~^ nTUCr^ ~~ ^T'- r <br />:RL1`_ r;S~? c. .nl,~ ~. .~!'r v'+Ii ?Ej!iTpcD jF VT~T°Lf ;;1 c;cy jr ~n^_^;rcn~ nr. ,...(y pv~T •ryr rv• ^,Ir?jn r7"-I.~•a• <br />EPA Form 3320-7 (08-95) Previous editions may not be usetl. (REPLACES EPA FORM 7-00 WHICH MAY NOT BE USED.) PAGE OF <br />