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PERMITTEE NAME/ADDRESS (LrYL Frd~ryNaN/lamlm (/Dls nnt) <br />NAME 5E;ic:CF CU.IL ~:0".=h.t <br />ADDRESS L G ^ ' ;- h L <br />dA~tuL^ CU ~lii3~ <br />FACILITY <br />LOCATION it A i ~~ L `~ C, ~ ^ 1 b 7 U <br />niih: S• LI;U !:?Un;:r .,. .-..(IiL ;eLG AI; ['U <br />NATIONAL POLLUTANT OISCNMGE ELIMINADON SVBTEM /NPDESJ <br />DISCHARGE MONITORING REPORT lOMR) <br />1Z-161 /7-191 <br />CUO 1;iJi~1 CO. A <br />PERMIT NUMBER DISCMMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM '7 ~7 ..1 v TO ' "~ <br />l1Q7I1 l?1-131 !14151 11171 118-291 !363/1 <br />Form Approved. <br />L . c ~ ; - . ,- • oMe NG;;zoao-oaoa ` <br />~~ ~, II E T , ~ ~ Approval ex ros~05-31-98k <br />L '~ <br />F TTI+AL Y <br />Iy~l. <br />NOTE:' Raad inatructlona'6afore eompletinQ this form. <br />PARAMETER 13 Grd On/yl QUANTITY OR LOADING !/ G :Only! QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> I4E531 l5bsll 38451 /06531 !50-611 EX TYPE <br />l31-371 MALYSIS <br /> AVERAGE MAXIMUM UNITS <br />~ NIMUM AVERAGE MAXIMUM UNITS <br />_ (s1-ssl /5/-5@1 169-701 <br />Glu AN ~ :;n:.. S.: <br />' SAMPLE <br />ME <br />S <br />RE <br />E <br />T ~: r. •: ._,: . O ( 9u . .fiy. t~.. ,; ,.~._ :. ... ,. ...~ ~"~ `/ ~ J <br />V ~ <br />V i .. S A L A <br />U <br />M <br />N ~ <br />4~,DC, 1 ~ PERMIT tx;t/k 4rtC iZE PO?~T - .'~>tiL 3;}i R~'.''.: ~_ t,: ;: ;,}r: ;; ~££~,LY /.I:~I~iI <br />ct i':.~°.`~ ,'r !.)5:: :, ,i! REQUIREMENT TlfST ~KAx ~i <br />5~= <br /> ~ <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 /> 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 CERTIFY UNDER PENALTY OF L <br />I <br />IT <br />THE <br />F <br />M <br />NFO AW THAT 1 HAVE PERSONALLY F%AMI <br />MD BA <br />RMATION SUBMITTED HEREIN NED MD <br />SED ON ~ TELEPHONE DATE <br /> ; <br />AM <br />AM <br />U <br />W <br />H <br />I <br />MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIB LE FOR ~ <br />/ <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMA TION IS / <br />~ <br /> <br />TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THE <br />IN <br />SIGNIHCMT PEXALTIE9 FOR SUBMITTING FALSE INFORMATION <br />RE ME <br />CLUDING ( <br />r <br />l <br /> , <br />THE POSSIeIUTY OF NNE MD IMPRISONMENT. SEE to U.S.C. L 1001 MD 3G TURE OF N <br />IP <br />EXECUTIVE <br /> <br />TYPED OR PRINTED U.S.C. F t Gt a. (/Vllel!(•Ir M\1Y IMM .6erh. m.Y NtcA.W rxlrs ~ ro s IO,ODO <br />eM wmuirwn lnpn'alrvn.rtr e/bewrrt6ntonNa ArMby.ra! C <br />610NA <br />AL <br />OFFICER ORA ORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReterencs s/1 sttechments hare/ <br />':':i.~ _.. ::. LIB°1~ +IL:. ',!. hAIYcU ;. 3t: I'T L'A~'~L_: 50LI ~" LT"+I'. AF'FL IF.I =CF !="?Y E,?UI!:; Pi~r_r~ i-V h'h T; T`:~F <br />itt:);.Jb .. L;;LF:F~;LF. SiiL::.S L1`]IT+ aAI'JLD Fp'? >1;it'v.?L~ii:~ ^4iSLIF EVF:,9 _`L'EJECq TG °CHL'`''+ OF PMi_C..° I.~ l.i,.,'.. <br />„T~. t, L:'it ,:ter - ,F I•' T.V.. I 'rr,; N~~rrrtkTFi C- (- _1_ -- <br />EPA Form 3320-1 108.951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.! () 0 0 ] ? / 9 ~ ] 0 3 ]- ] ~ 1 i PAGE OF <br />