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P <br />PERMITTEE NAME/ADDRESS (/nclude FaciliA• Name/Locanon if DiffoenQ <br />NAME `CYe nllc F".i r_ ftr !-f~p'~-1 -, ~.TT1R <br />ADDREaScA~L-± .:,r+,~~ ^~~vT-ev <br />Clid: "1 Pj F?1r <br />FACILITY <br />LOCATION <br /> <br />NATIONAL POLLIrTAM DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(2-rel f1]- 9) <br />r~nnzr.Tnz n,t '4 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM v q r7 r. 7 j TO 7 n ~. r ~ ~ <br />(z621) pz-zJ) (zaz5) R&zl) R&z91 (aaap <br />Form Approved. <br />w T ` OMB No. 2040-0004 <br />Approval expires 0&37-98 <br />(c~tno '.'1 <br />P rr.~AT v~; *, <br />.. r r.~.'It ,, n.,~ gTrT T1Y~ r.1 !: q <br />NOTE: Read Instructions befo ' completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Ce%d Ony) QUANTITY OR CONCENTRATION N0. FREOUENC SAMPLE <br />PARAMETER (4B-53) (5a-61 (38-45) 46-53) (54-Bf) EX OF TYPE <br />(~-3]) AVERAGE MAXIMUM UNI ~ MINIMUM AVERAGE MAXIMUM UNITS <br />(eza71 ANALY51s <br />1i4-5B) <br />6870 <br />n'JLI`J3• TnT~1 SAMPLE 'irk.?R~ F..a r.t•; '. ~,.. ',S+t ij iY F,.R ( 11) <br />UISSOLV'.il MEASUREMENT <br />7U''JS ( D 1 PERMIT +tk+#10s1741r 41t~IFQa $ m~'ROtT47 1#}!1"IfiRAL TRI.r '??An <br />:: F' F L 7 c !c • ~ P n " ~ Y 0. ?. I' I ~ REQUIREMENT - ,~, r. .•... r • _ ~ 7 !r ~ / t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT- - - - "'~ -~ <br /> REQUIREMENT - ". <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '.*:`° <br /> REQUIREMENT + r,~ ~r ,;'4 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :ri'-• <br /> REQUIREMENT r,;=;~,- ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - " ~ - <br /> REOUIREMENT - _ 4 _ - - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERnFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY E~(AMINED ANO <br />A TELEPHONE DATE <br /> SED ON MV <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND B <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />Richard Milis THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ r <br />' <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT : 7 ~~ <br />i .r i !l - <br />70-870-2712 <br />7 <br />28 <br />99 <br />Environmental •Manager PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br /> POSSIBIL7IY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 41001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED meximumllmpn'SOnmerrt of beMreener~rron(hv~ ~fijas uproEl0.o00 oritla OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />i ET'"LF,AiILF ~1LT". ~. T., T^ g}.Tycn c,7" >(0T^e iq:rP '1^rT.rc' avcyr_., i`^ +~p~Tr or -11r r~rr _•.~~1gTS. r.,. <br />,: i?°R$.; ^,Rl(R. ~8"p(.~ FY4Lrtije c: r'.')IIIr: r.7 T'' VT.I°T S:'^r.l (', t^n;^..r-nom nn...c.v a-~••of f4r, 1••~r RtiC*Tr, .t~_Te--en <br />EPA Form 3320.1 (O$-95) Previous etlitions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF <br />nn~SD/;91nu17-y~2'~ <br />