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PERMITTEE NAME/ADDRESS(l..Ab F.-WryNa.WL«mo. l/Dld....q
<br />NAME TA:1c'!= J .I`.i',4, [..C.
<br />ADDRESS T h A E• ? I'' ~ i 7, }
<br />P.U. ;i1; '.' 7
<br />C.4Ai..
<br />LO 5:67.0
<br />FACILITY
<br />LOCATION
<br />.'1i1.: a. 1.0~^, ('J~' k'.."'t~E'- nii};/~Ln ';'~F;
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<br />NATIONAL POLLUTANT DISCNMGE EIJMINAl10N SYSTEM /NPDE$l
<br />DISCHARGE MONITORING REPORT /OMR1
<br />r7• I s/ r7-I9i
<br />000032115 CCS
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM i ! , V TO . _ =
<br />170-III 111-131 111-751 11617/ /18.191 /.90-311
<br />Ci~CHAF(:E
<br />(~U.°. C1 D'w)
<br />e _ eIRPI
<br />`IhCF
<br />Form Approved.
<br />T 0 +: f1 Y C~!B N9r;~Cw`0004
<br />Approvahe>Sp~rp4-X05-31-98
<br />NOTE: Reed inetruetlane before eompNtlnp this fam.
<br />PARAMETER !3 Grd only/ QUANTITY OR LOADING /t Card only! QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> /1653/ 151-811 38-151 /1653 /51-511 DF
<br />/31-371
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<br />UNITS
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<br />ANALYSIS
<br />151.581 TYPE
<br />
<br />/59-701
<br />., SAMPLE ..#4:.`- ?:;:#>r'.::~ 4444r,:.. ( 12)
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<br />r a.- , t0'I .t~ '. ~)R SAMPLE ( U3) 4~4494 444#C,4 4r, ?+5::;:'.:
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<br />NAMERISLE PRINGPAL EXECUTIVE OFFICER =CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON
<br /> MY INQUIRY OF THOSE INgVIDUN.9 IMMEDIATELY RESPONABLE FOR
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />~-~
<br />W. Gordon Petare TRUE. ACCUMTE AND COMPLETE. I AA1 AWARE THAT iNERE ME
<br />SIGNIFICANT PENN
<br />TIES FOR Sl1BMITTING FN
<br />SE INFORMATION
<br />INCLUDING .Bs ` q70-824-4401 96 4 28
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<br />THE POSSIBILITY OF RME AND IMP1e SONMENT. SEE 11 U.S.C. 1 1001 ANp 73 iIONATURE OF PpNVCIPAI EXECUTIVE
<br />
<br />' U.S.C. 1 1 ] 1 B. (Mylri. Iw/Fr dtiw WAwA mrY I'InEeI/ r.'I.. W b f IO,DCO
<br />OR PRMITED
<br />TYPED wrTnl:rw./,IO+:dnwewan+..,,emona.wsrw..l OFFICER OR AUTFIORQED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRderence d/ eBSChmmts here/ - --
<br />,.i.i 0 'f0°'nL I~U'd LIMITS GILL Fdt I+AIYEU, ANU ~ET1'LcAF'EL SO1.IC5 1,I!!IT AFFLIFC FCR <=lOTk,7U!iD PP.cCIP i:VrN'"-
<br />~tc E4UriUEN 0.° P%-.0(%F RE;q. I'INL`I F.:iTS i1ND16 I.A. 3. ?ER".ITTfE Mll°T IAMI All 6~'ASChAFLF CSA~IIRc, Tq He1~UCF F!i
<br />ti ,+ v - _ c ~
<br />EPA Form 3320.1 108-95) Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) G G (~ 3 9 / ? 7 1 ? 11-164 ~ AG ~LDF
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