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PER NAME/ADDRES$(Incfude Facilip•NameJCOCalion iJOfferen!) <br />NAME <br />'YF•Hi,, q'+P~nc .^~r.~O:ArT;TN <br />ADdAESS r. R ~ L" • T v •. .• 7~ p P~-Y <br />FACW1Y C. n_' ~~ 9l rt art <br />LOCATION <br />A 'TTA_ /1 l:~:14°C F_ 7A lrG v_O_ <br />-. <br /> FOrm AppfOVBd. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) 2040-0004 <br />OMB No <br />DISCHARGE MONITORING REPORT (OMR~ <br />rz~+sl (n- Bl ~ - •~ ^ <br />o . <br />i <br />OS~T <br />98 <br /> . res <br />- <br />Approval exp <br /> <br /> PERMIT NUMBER ~• DISCHARGE NUMBER r. _ -~ • M 1 C 3 <br /> <br /> ~ ^ ~~~ L P '' ' e ~ ^ .r <br />l <br />' ~ ~~ ~" ~t '~ T f <br /> MONITORING PERIOD . <br />. <br /> YEAR MO DAY YEAR MO DAY <br />FROM ') ;~4 tl TO ^~ nr tn, y.t !: rte r• ^r~'1 bf~(i t. I I :i-.. <br /> rzazn za.Tl !z4-zm rze zrJ rzs~zsJ (30aD NOTE: Read Insfru~ti~ns before plating this form. <br /> <br />PARAMETER (3 Card Ony) pUANTITY OR LOADING <br />(46-53) (54.61) 14 CeN Ony) QUANTITY OR CONCENTRATION ~ <br />(3815) (48-53) (54-6+) NOS <br />EX FREOUENC <br />OF SAMPLE <br />TYPE <br />(32-37) AVERAGE MAXIMUM UN - MINIMUM AVERAGE MAXIMUM UNITS <br />!6463) ANALrsIS <br />tW-BS) <br />6&7D <br />UIL ANIs I;NE 4 ;~' SAMPLE nnaa r.0 ( ;/ <br />~ r.yn nt«:. .. <br />V I.+'1 A L MEASUREMENT <br /> <br /> <br />iiN,^, +,r i rJ (t <br />`.PP'LI)°'n;i rc,5 V3.l.++l <br />PERMIT <br />REQUIREMENT <br />R4440R <br />~.' '-," <br />Mry"I"': <br />~'~=I <br />NO-D <br />,t <br />}~ <br />-. 414`Mk444h <br />"it`.; <br />i!fr?4th <br />.t.. e. <br />Yrg(st~ <br />F!'f~ <br />M yy <br />T~' <br /> <br /> SAMPLE <br /> MEASUREMENT ; ' <br /> <br /> <br />REQUIREMEN~, <br />~.,~.; - <br />,.+,'~. '. <br />d`," .~, - i'. .. ,er- <br />- <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> PERMIT <br />AEOUIREMENT - <br />''~ ~ ~ ' '~ s."' <br />_~, .t ~T ~ <br />::fir' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />~ - ~ <br />~ a'~. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />~ <br /> REQUIREMENT , ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERM17 <br />REQUIREMENT • <br />m <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT - ,. 'f ~:~ - <br />NAME(TITLEPRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENPLTY OF LAW THAT I HAVE PERSONALLY EXPMINED AND TELEPHONE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY <br />Richard Mills INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ t <br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, / 97O-B7O-272 <br />Environmental Mana er ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFlCAN7 ' r ,- r.. _ r ".l' '~ <br />9 PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF~PRINCIPAL EXECUTIVE DATE <br /> <br /> <br />7 2EI 99 <br /> 000 aid or <br />inclutla tines up tp 310 <br />t31e <br />at antl <br />r th <br />e sbMes ma <br />P <br />ll <br /> <br />TYPED OR PRINTED , <br />y <br />§ <br />. I <br />ana <br />r <br />e <br />es <br />maximum rmpdswmam of Senrean6mondu entl5ysam.) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />GOMMtN I, ANU tAYLA1VA1 NN VF XIVT YIVL/111VrvO Inetnroncv au atuacnruvuu ueio/ <br />iE'?'?'LtiABL; 4'1L!"'" I7`•Tr .,;V*'D FOP >LOYRr2U9Z {?ocrTn cV:•q,l•_~.•^ >'~e~~r nr• .yr rnr• cr,^,tTprMol•rS~ nTr . <br />(: F.E:n~' ;;flA°_ `411"pi." A~:AI,T;TS F>tJpTn"'T IF VTSTt;L: rNr•.N I` Rvgv7Vrh. )aTOj.v q(srsr~.•r T.~,.T.(gC.r7nH~-T.^.p• <br />EPA Form 3320.7 (08-95) Previous editions may nol be used. (REPLACES EPA FORM 7-40 WHICH MAY NOT BE USED.) PAGE OF <br />