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~' <br />PERMITTEE NAME/ADDRESS pnelude Fpcillry Name/Locanon iJDifferenq <br />NAME f.Y r. ,i~~ ~ ..r 0•• r-t~lP'1 ~1'.'[(; •d <br />ADDRES3F.ACL: °I'.4 '^,°''! °Y <br />r i•3i.. ,^n nT r, ter, <br />FACILITY <br />LOCATION <br />='r'. <br />NATONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCIZAR GE MONITORING REPORT (OMR~ <br />Iv. sl <br />PERMIT NUMBER ~ DISCHArGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 49 ~~ 71 TO "" -" "' <br />(26 (2223) (70.25) (264]1 (1&791 (3631) <br />Forrn Approved. <br />OMB No. 2040-0004 <br />"' ' ~ • Approval expires OS-31.98 <br />r_,1.,r. '~c;l <br />v.i ... r ~'3~v' T!~ TIT 1,.. .- r/rq ~' <br />~NOTE: Read Instructions befor plating this form. <br /> (3 Card Ony) QUANTITY OR LOAD (a Card Ony) QUANTITY OR CONCENTRATION NO. fREOUENC SAMPLE <br />PARAMETER 4653) (54.87) (3B-45) 4653) (Sa-Bf) Fj( OF TYPE <br />(32-37) AVERAGE MAXIMUM <br />IT ~ <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br /> <br />lee-WI <br />ANALYS/S <br />s4-fiel <br /> <br />69-70 <br />JIt, a!: L' GRPRSF' SAMPLE °'*^:;: r.. ( rY (!f}9h'} .. .. .±, ...~.;,. <br />V I ~; II a L MEASUREMENT <br />R+1 :}[:p 1 [1 D PERMIT QgI+GT00A ~ ~..r -r ~^_', ..$'. ,p4itrOl3gr ~a4dtrl?'K4 '' 1If"Pr Y$~.. <br />F.F°i. [: FT :F'l5_ VA: "% REQUIREMENT ~~~ ~• ~"~_~ ~" ik - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s <br />..'-:;F '~~ _ <br />~ - <br /> <br />REQUIREMENT , <br />~' ~" - _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~~ £ - <br />?'~ <br />~"` ~``• ~ <br />- <br />T <br /> <br />~ <br />``~' <br /> REQUIREMENT ' <br />~',Ly:T+ , .~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT= - - <br />REQUIREMENT ` - <br />~ b+~~" .. I ~ '" <br />~ <br />- - <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT- .. <br />~ -: <br />~ }, .. ~.~., . <br /> REQUIREMENT c -• <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~. ~ ';' ` <br /> REQUIREMENT ~ - ;~_" •';~,, ,-~ . ~±,d sr -_-•, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - <br />~ '~_:~ <br />~ <br />~ ~ - ~ : '- . <br /> REQUIREMENT <br />1 <br />ri - <br />, <br />=~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WfTH THE INFORM LAW THAT I HAVE PERSONALLY ET(M11NED AND <br />ATION SUBMITTED HEREIN' <br />AND BASED ON MY TELEPNQNE DATE <br /> <br />I{ C a r S <br />INQUIRY OF THOSE INDIVIDUAL , <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING _ <br />~ ~ ' <br /> ~ ' <br /> <br />Environmental hlanager THE INFORMATION, I BELIEV <br />ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTING E THE SUBMITTED INFORMATION IS TRUE, <br />I AM AWARE THAT THERE ARE SIGNIFlCANi <br />FALSE INFORMATION <br />INCLUDING THE ~ <br />~i ~~•~. 1~-,~• 97~-87U-1712 7 26 99 <br /> , i . <br /> POSSIBILfrY OF FINE AND IMPRI SONMEM. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> ~ <br />l~p~ <br />m 5 ~ Ernes up b 5/0,000 vre w <br />reB ern <br />n <br />TYPED OR PRINTED mum <br />onme <br />or ~txee <br />p n <br />~ e <br />d <br />yeers.l OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RelerenCe ell alfechmentS here) <br />F. v•rT CAFE' {l[ • 4r r Tvrv T r^ P U ~ Srn [`-'F^ Cr^_ <br />~r .. V ~. 'l? >17 T. ~:0 ,. '?V ^rr n, 7~ n^ ^p~ o~c I~c~,r Tnpty~oTC -. rr , <br />.t.ngF Gy9n ^Rv~l.i A`. AL~SI i Dc if7I RF.l T° 7Tgru[ -: rai.cti T5 '1Pecnn v'1. ••o~`a r.'+ Irv?T TTIr TNST RTt ^'"T~'#--? •° <br />EPA Form 3320-1 (OBAS) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />!1^~U2/970a1~1<~23 1 <br />