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PERMITTEE NAME/ADDRESS (/ndude F'oci(iy Nmne/Location iJDifferenq <br />NAME <br />(.y C-:Llc F."-~TTnr r-r1c:,rJay rrlu <br />ADDRESSv.p;Ls rTtiF ^-n'+pTrr <br />p~~7• 07Y f c. <br />FACILITY r p it f ~~ ~'~ E)1 Fi 7 6 <br />LOCATION <br />NATIONAL POLLUTPM DISCHARGE EDMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (OMRI <br />(2-181 (1]~ BJ <br />~-.n~~nT 117 ,^T• <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY. YEAR MO DAY <br />FROM 99 ^5 ~] TO 9') fir., i0 <br />120-21) 122-23) (24~251~ (2621) (29 M) f00d1) <br />Form Approved. <br />OMB No. 2040-0004 <br />"' `p ^? Approval expires OS31-98 <br />c - v,rl <br />r ' N07E Read Instructions bef pleting this lorm. <br /> (3 Card Ony) QUANTITY OR LOADING Ony) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br />PARAMETER (46-531 (St-s1 (3945) (48-53) (54-sf EX OF TYPE <br />(32J7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />/62dJ/ avaLrsls <br />(64-68) <br />6370 <br />JC)LTi)ia 'f ll; ii SAMPLE K, In pa :4 ac-Yp•, :; ( ' O~ <br />iJ 1 5'~ O L Y E j MEASUREMENT <br />!,)2'1S ] U J `PERMfi" O~TRtR;ap @¢RA1[ <br />: <br />" • •. •, RddCR4 !}+~,' '• <br />" <br />F. F f' L U t. N'i (: f' 7 ° ' V 1 i •' 1 REQUIREMENT ` <br />:, r •. ~ k >1.i}.i _ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ ~ <br />"s ' <br /> <br />REQUIREMENT . <br />' <br />.~ <br />a I <br />• " <br /> . <br />,, <br />. :~ <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT". -... "a:~ :'..p.,s~;,, ~" } s .. .. <br /> REQUIREMENT _ - ~," " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />" <br /> REQUIREMENT ~'. pr ", <br />~.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "" <br /> REQUIREMENT "" " ~~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />- ''~"` ~ ` - <br />± <br /> . <br />REQUIREMENT - - <br />- `' <br />~+ - 4 ~ <br /> 4 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -~"~"`~" <br />a <br />r <br />, <br />' <br /> REQUIREMENT . <br />r <br />xsw <br />,r.. <br />HAMERTTLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY ExAMiNED AND <br />M TELEPHONE DATE <br /> <br /> <br />Richard Mills AM FAMILIAR WITH THE INFORM <br />INQUIRY OF THOSE INDIVIWAL ATION SUBMNTED HERE <br />S IMMEOIATELV RESPON <br />T <br />T IN; AND BASED ON <br />Y <br />SIBLE FOR OBTAl111NG <br />F <br />M <br />O <br />TRUE <br /> <br />~, <br /> THE INFORMATION, I BELIEV HE SUBMIT <br />ED IN <br />E <br />T OR <br />ATI <br />N IS <br />, <br />E <br />A <br />GN <br />I <br />NT . <br />~ <br />'~ <br />~ /~ <br />~ <br /> <br />Environmental Mana <br />er ACCURATE AND COMPLETE. 1 AM AWARE THAT <br />H RE <br />IF <br />CA <br />RE SI <br />H ~~~ , ~ <br />,~ . q <br />970-B70-.712 <br />7 <br />28 <br />99 <br />g PENALTIES FOR SUBMITTIN <br />POSSIBILf1Y OF FlNE AND IMPR G FALSE INFORMATION, INCLUDING T <br />E <br />ISONMENT. SEE tE U S.C. § 1001 AND 33 U.S.C. _ <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED § t319. (Peru/fles under mesa stetuias may ixNde hires up ro f10,000 end or <br />marlmum,mprismment of beMSenBmontla end5years.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND E7(PLANAI ION OF ANY VIULA I TUNS (HB1erenCe all atta0bmanI3 pBreJ <br />"F.°TL""-'~~Lh. ^~TS°~4 r=r~^ eTYvr. v7c )tflvos21;i~ e1)rr^~ ~fc.•T_r TaaaTe pr Tp r^n ~ vr+ITRCVtryTS~ nTL r <br />u R:;kSE L~G: +1 `! ;1P='l.~ 171lLY'iT5 RF?UT 4FD T° Vi ~r 41,c ~,, .. r: .; ; (i r.^,r^g c!1~ c,±^.. .rn. .,, r, ,., .: r^,>tlr T'r 71g5_T o <br />EPA Form 33261 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />