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PERMITTEE NAME/ADDRESS (1Mib fasieryNaaJfaanen JlD,fmnr) NATIONAL POLLLRANT DiSCNMOE Fl1MINATON SYSTEM (NPDESf <br />NAME ;. y_- - .`II es ~ I/ ly,. % ~-r T ., ,- ~ x ~ W ; ! e DISCHARGE MONITORING REPORT (OMR1 <br />11-761 l~ <br />ADDRESS ?~ I. 'a t. L K r 1 N V ~[ r r. <br />ty,tr,t u ~^uu(ty E . (3 {t atrt M/co ~~ r PERMIT.NUMSER OISCHAROE NUMBER <br />J p,-: <br />~. ,.:.,,. E v . I I ~ ., N , , ~ ---.F., <br />FACILITY ~"'~ s ~ T N H l'1 1 MONIYOAING PERIOD <br />Sd :Lx pnc ~.irnrn¢s~S A/[...A E. 14. µ.nE MO DAY YEAR MO DAY <br />LOGTION N .i.. ?~ J N ~IV, ;'.7 917 41 FROM ~ J TO ~~ •) ~ <br />;`y: T^u .: r r4.y;~y "~i ^_1 ~R a•4lf_ `+^R_ l1 ~131I4.151 !16171 l1b-19I 134311 <br />Form Approved. t <br />-L.. .~... ..,T.~,O 004 <br />' Ap rdvel a I•rea 5-31-9$ <br />°:NnD <br />p pT }~~ •: Y::• <br />~NOTE:~IReed Git7v ~o(~, 'e~wiQ6TEl~hetinp this lorm. <br />PARAMETER !3 Ard Onlyl QUANTITY OR LGADI !I Grd only) .QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> 16531 154-67/ /3B~bl !1663 15161 DF <br />/31-37I E% <br />ANAlY515 7VPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ref-ss/ /64-bBl 169-)Ol <br />i,...t'J `, T,0. I'.'.r yql;rr q;r SAMPLE ~x¢F7'': PRP?r^. :.^:,e #'#:~ .. ( ?1) - <br /> MEASUREMENT <br />C :'~ : U S A V'I ^! I A <br />.."A' !ti l U ;) PERMIT ata0.'#'A~.. <br />~ ~ ~~.'sgQ."tb Or~ Cnr <br />.. „L~.::...... <br />. .. <br />~ <br /> <br />q <br />~$ fi0'ISYfS'C ~~_ tf I.: F{.', F! <br />-.. ~REQUIREMEN7 ~ . <br />; tc: ,! 4 '~ ~ T <br />, <br />L'.:'~J .`iT0.l'tif; YtiPV n.{'I SAMPLE aaaaca afi50^'k 4fi ST qGC - - ( ~ f) <br />F : ": 1': F'1 M1 L `; S MEASUREMENT <br />7'A'+JC 1 U () PERMIT ~~ ~ xfi¢rgrC dR~4q~~r ~ R;'. 1(lti ~ ~ ~~>j(eg3AeAlds. ~ akgOKtid. F.,_ .'O~P <br />GY T-RAC <br />`.F,"LJFM" ~ c5 YA ~REDUIREMENT ~ ~ vfifi ... ~ „~.. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT ~ ~ ~ ~~ ~ ~ ~~~~~~~ <br /> REDUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT ~ ~ ~~~ <br /> ~REQUIREMENT~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> .. PERMIT .....:... .. . <br /> .REQUIREMENT ~ ~~ .~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ - <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I OERTI <br />AM FA FY UNDER PENALTY OFL <br />MILIAR WITH THE INFO AW THAT 1 HAVE PERSONALLY E%AMINED AND <br />RMADON SUBMITTED HEREIN; AND EASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIELE FOR <br />A 1 j~R <br />r ` <br />l <br />1 OETNNINO THE INFORMATION, I BELIEVE .THE SUBMITTEO INFORMATION IB v <br />Y <br />/t <br />~ 1 <br />1 TRUE. ACCUMTE AHO CfMAR.ETE. I M1 AWA11E THAT TH EAE ARE <br />SIGNIFICANT PEHAITIEe FOR SUBMITTIND FNSE INFORMATION <br />INCLUDING ~ <br />' <br />A r , <br />THE POSSIBILITY OF HNE AND IMPRISONMENT. SEE to U.S.C. 1 tDOt AND 7J v ~ <br />IOHATURE <br />F PIIINCR'AL E%ECUTNE 7 1 <br /> u.S.C. t t~1E. IMWaia urdar ewe mNha my NcAda ra»a w ro F1D,ooD QQ <br />TYP DOR PRINTED aJa anraimun implaawwNe/blwwn snwnNaaMSyaara.! OFFICER Oyi AUTHORIZED AGENT CODE NUMBE YEA MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference sll ettsehments here/ <br />;=° C. .1. 1, ^c~ ti-/, f'~: ";PIES 'IF TEST ~pnC? UR'. "F.^:-4~ 1.^'~~i - STATISTICAL n~:'I'" °e*LMATE V11LCN i" <br />i.`i'.~AL TJ S!!'. )F 'fF.S^ I:C,;ANIS`ISa A9D ATTACH A=UYE 'P`jYICT_TY :^~;5^. REP09T F~)R>•! T(1 T?".P. C7E'LES OQ 4i !. <br />EPA Fwlii'3 2 - ' -STI "PlevibuB aditidna'me a UB (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) PAGE OF <br />OAC~t7/7G121T-122? 1 <br />