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PERMITTEE NAME/ADDRESS (IMLb FslhryNa•JLoeaflw dDfga,•rq NATIONAL POLLVTANT DISCHMOE ELMINATON SYSTEM (NPOESJ <br />NAME r - F P r ~ ~~ w r ¢ DISCHARGE MONRORING REPORT lOMRI <br />(3-161 17.191 <br />ADDRESS !i r vi ',: L f " (} C ~ ~1 <br />' ~ (} ~~ ~¢•+'~ wuoX ~,,/e ~ -'•PERMIT NUMBER Dls AROE NUMBER <br />7,T',"t`'~1r' E v ~ ~ s V • (I a 'CQ-1t1"7Y~- rN 47T 11 <br />FACaITY MONIT ~ G P O <br />' ~ r - W ~/ E 11: H : n ~ MO DAY ; YEAR MO DAY <br />LOCATION U :1 .•~q h, L, I~R'^~ v0 B1J91 FROM <br />':TCN: • 'S R,~tl Ll. A^.O_ anon i rocon rea_ool cvtafl <br />Form Approved. <br />AC:IT: aF'.. T~.-...#.,rOM~rS~P•~~~IO'P04 <br />(^ Ir n D S r) ApProvel~xpi(Q~SO5-31-98 <br />- F'I°1~L r <br />*' T'10 <br />«.... ~n DI~CHARG.° r.:~~.: <br />NOTE: Reed Inetructlarr before completlnp this form. <br />PARAMETER l., ~ rd bnlYl QUANTITY OR LOADING rd OnlYl OUANTITY OR CONCENTRATION NO, FnEOUD+cY SAMPLE <br />I3I-37/ !/6531 /50-6I1 (3BJ51 1-53 I5L611 EX DF TYPE <br /> <br />VERAGE MAXIMUM UN ~' ~ <br />MINIMUM AVERAGE MAXIMUM UNITS <br />rrz-sal ANALYSIS <br />l5~-sgl <br />1e37o1 <br />LC}0 S'f~TdC 4R!!R AC SAMPLE .i<rFG.^ ..: .. ,.. .. ( ?3) <br />r ., ~+ I U D A'"i R I R MEASUREMENT <br />T S ." J "t ] t# •+ '. <:;:.?:P RIyIIT. ,..: a .a+za~.fi:,~:( -~. ~. ~.a*IIr:a~i~li::::` a x::;: ~1 n0 ~ c,~;,.,....y ~. #Yr'.>. >sRzfr : . c q_ . . T:k I;'f~ .^. (??!$. <br />,. 1 'R„q ENT <br />• .::::.::...:.. ...: <br />~: ~ :,:;~ ~ . <br />:;.~:,.~::;:.:~.~:~~.::",:. <br />Corgi <br />.I#!f.. ~Q~11Ltt..~ <br />: ,: <br />1-r.,)T <br />.. .. <br />L#:5~? ~T1"'iF. YS:!;' 4^I SAMPLE hxa~F R¢?~O .. ..Y. ( 711 <br />P T" :i D H A L i? 5 MEASUREMENT <br />T it ;: •,L 1 U 4 PERMIT ~: ~iA'~'I~#IRG~.. .taa~Rri..~a':. .~Q~ ~ ;».~tr~rr;:.~^ CS:.`Jf+''T: ry`' (.`U_ T~ <br />. ti L. r. <br /> <br />.q .. <br />''F'%LU^:~T ~RU55 Y111.U REQUIREMENT :.. <br />~:~::`s>?,, .. :~:, ;.:::.. ~~ ..: 0 ~ ::::~:" LC#- <br />T ![ ~ ~ "cvT <br /> SAMPLE <br /> MEASUREMENT .~, <br /> PERMIT ~ . <br /> REQUIREMENT ~ ~ ~ ~ . <br /> SAMPLE <br />MEASUREMENT <br />) C ~ <br />~ 6 <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> .:REQUIREMENT ~ : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ ~ ~~ <br /> ~pEQUIRENIENT <br />NAME/TTFLE PRINCIPAL EXECUTIVE OFFICER I cERn <br />AM FA Fr uNDE/1 Pv1uTr or <br />MIUAfl WITH THE INFOR uw THAr I HAVE PERSO <br />MATION SIIeMITTED H NAUV ExAMIN <br />EREIN <br />AND BA EO AND <br />SED ON TELEPHONE DATE <br />A - 1 r~tV r y <br />/'t L 1' ; <br />MY INQUIRY OF TNOBE INDINOUIV-B IMMEDIATELY RESPONABLE FOR <br />OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IB ~ ~ <br />1 <br /> TRUE. ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE ~ <br />( <br />` <br />.A <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATON <br />INCLUDING nn pp -r <br />- <br />- <br />II L <br />U <br />r ` A 1, ~ ~ E , <br />T <br />ABI <br />TY <br />E P <br />F 31Z 172 <br />1 <br />]~ 1~ ~ ~ U <br />l p <br /> H <br />OS <br />U <br />O <br />RNE AND IMPNSONMENT. SEE 10 U.S.C. F 1001 AND 9J <br />~ B ONATUIIE OF PIIINCWAL EXEt~ <br /> <br />TYPED OR PRINTED u.s.c. E •»a. rlw.m <br />., r.w• dae..bruh. nf.r 1nchd• rr», w ro e rooao <br />.rwnmuh.•nMArrAOmwnrw Nwfan sn~mrno enss F•ra/ <br />OFFICER OR AUTHORED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />wmm[n I a wnu urLwnw nurv ur wm vwLn I was Irterermn sN srmcnmsnrs nets! <br /> <br />l.,,. <br />' " <br />.r <br />_!°~ t"41Li ~)' try. ~r)i. _•rl - :°4 <br />T <br />~•')~ti'?I^ <br />"'1 ci ^v <br />`:"ft'd' u~I+T "Tt'A <br />Tr'-; # <br />„•~ <br />.. <br />. F F .• <br />~ <br />..I. 'A1, .: }f'. ,.. T~,~p .1 .t..I,r ~,~ p4'1 trl k'.1.~ T')RT~I"Y rc~ 'i-~rl•. cn:~•, m.~ .."'9. .,'+nTcc :)r 7LL <br />t:~G^IDAB rI'tN +In :r as qr+.r rn EDe- <br />FPA Form 3320-1 108-95) Previous editions mBY be used. (REPLACES EPA FORM T40 WNICN MAY NOT BE USED.) QO 0 71 / 461 21 3-12 2 ] PAGE ~,OF <br />