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PERMITT E/ADDRES$ (/nclude Facility Nome/Lacanan JDigerenq <br />NAME r :, II c n r• <br />ADDRESS c „ r + .~ <br />` P.t'I. s;nv r.~ <br />FACILITY <br />LOCATION <br />A't'T':. .4Cr-UP ;r yAJr:R, r . <br />..F <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ <br />DISCHARGE MONITORING REPORT (D <br />MR{ <br /> <br />(2-/6 ( <br />91 <br /> <br /> ^~:l 'l lflt• 7 n r <br /> PERMIT NUMBER DisctlnRGE NUMBER <br /> MONITO G PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />FROM 99 +75 9t TQ ~~ 7F '" <br />(2(}21) (1223) (2425/ R&271 (28-291 (30311 <br />Form Approved. <br />OMB No. 2040-0004 <br />'' ' ' ~ •~ - Approval expires 0531-98 <br />Y-,I'r :r ,:.1 <br />NOTE: Read Instructions betore'bOTnpleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING, (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) (54-61 (35-45) 46-53 (54-61J EX OF TYPE <br />(32-37) AVERAGE MAXIMUM ITS MINIMUM AVERAGE MAXIMUM UNITS <br />razes) ANALYSIS <br />(sa-s8) <br />69-70 <br />,'"(li2'JSe m~~rgL SAMPLE {v :t ~.n Cn ahtt_n,, rtr..^r:A,. ( i1 <br />Il T ~ 5 "~!, V F ~" MEASUREMENT <br />7i1; rS ] ^ '1 PERMIT Y04ipP0 `Rr0 Y>vc !`RP.kRR'! a{t]'tfl4At. *RIt' .`+NAlJ <br />r'rc•L'JcH'^ ,;n~^~ Rer ~• AEQUIREMENT ~ ".. -" crraz ': ~"" <br />R V^ <br />~~~ y <br />...-./T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />0 <br />3 <br />.. ~. " <br /> REQUIREMENT '; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ - -'.;~" a <br />. ' <br /> <br />REQUIREMENT <br />.. . <br />( T•';-' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> AEQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT.:. " <br />" ,~;_-•.. <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~'~~ <br />~ ~' <br /> REQUIREMENT ,,. <br />.,,:- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. <br /> REQUIREMENT . <br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINEO AND <br />AM FAMIUAA WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY TELEPHONE DATE <br /> <br /> <br />Richert! MIIIS INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, r <br />' ~ <br /> ACCURATE AND COMPLtTE <br />I AM AWARE THAT THERE ARE SIGNIFICAM <br />~ <br />/ ` <br />9 <br />l ! <br />E <br />t <br />i . <br />PENALTIES FOR SUBMITPNG FALSE INFORMATION <br />INCLUDING THE `" <br />~ <br />r S7O-H7O-27t2 7 28 99 <br />,, <br />anager <br />nv <br />ronmen <br />a , <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE la U.S.C. 4 1001 AND 33 U.S.C. - <br />_ <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED meximumimeM O/b~iwsen~e marth~v sold SUtle llrres up bS10,000 endw <br />pn Ieers.l OFFICER OR AUTHORIZEDAGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.="T*. LE:A~•!-% `; "'LIB: T.I"T." GATVE'J F'~°' ~17Ypr'4?"r% Ira pT~rp cy ^•tr_-r co +q+Te nr• r~r r~q orrnr T^vql r.ry~c+ n+T <br />CRi.45E dP rgrnry eNAS.YSTS °=''111P") IP ^+SI?Lr ^``''V !° (lnevoVt•n+ .: I1r.rY ~nr]Tr(: TNGTRfIf?•Tr`tir;-* a <br />EPA Form 332x7 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />0~'1nF/n.Tr1:? 2-152 1 <br />