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PERMITTEE NAME/ADDRESS (I.eii F,rdlry Nw//a,Nu. UDralrnrl <br />usuF OAr. ~. ~. ~ ~~ . <br />sCA~, ., „-. ... r <br />I~ i7-1 ~ ~ ri ~~ Q <br />NATIOMN POLLUTMT DISCNMOE ELIMINATOM SYBTEM (NPDESI '~ FOrm Approved. <br />DI6CHARGE MONITORING REPORT IOMRI OMfl No..2040-0004 <br />n-rsl n-lsl S S r :: ~~ -~'• . '. r~ . <br />., } _ 4 f. ~ T ~+ ApproveLexpirse 06-31-96 <br />PERMIT NUMBER DISCNMGE NUMBER ` ~' ~ a <br />r - FI 4I. <br />uJ N <br />MONITORING PERIOD <br />,a <br />=m! JA .::; <br />"• ~ ~ YEAR MO DAY YEAR MO DAV <br />__ <br />~a )N w T-i m FROM ) 1 OT 1 i TO ~ i .. <br />.. '. <br />1 7 '' ~- i I ~" , . ~. <br />y `: [1 I <br />~ <br />. <br />NOTE: Resd kTStruetlons balori Soinpbtinq this form. <br />~_ V t) . ~_ ~ ~ ' ~ c ~ ~ ~' 170-1 it 117-731 /14151 !36771 l7B-79I 136311 <br />~ <br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !1 Grd Onryl QUANTITY OR CONCENTRATION ~ Np, FREQUENCY SAMPLE <br /> ~ 146531 (56611 /3B-s51 !06531 15451/ <br />EX OF <br />/JS-371 .N M.ursls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS le7-s]1 150-5B1 169-701 <br /> .. SAMPLE .. :~~:<::: .:3 t64~ ~..' ., r - )~ <br /> MEASUREMENT ~~ <br /> -,.;~ 1 "v ? PERMIT .;:?~.: ;; r'G .. ,:F{< r ::^ j6.5 ;YM.G r .~ <br />• :r LV O:~IfI. <br /> ;.7 ~Xf 't.. 'f ;. REQUIREMENT :;I::: T, ara.~,• Nr T~«trtr <br /> ..: Jj, TJP.;i. SAMPLE .,_~.rr. ~.? RLT it .`•P `: -:3Fu:; ~.. (/(~~) <br /> ~ , r ~; ti L F. U MEASUREMENT <br /> . »J 1 U 7 .~ PERMIT ~. rt;Y Cr ft:rt to-aGra t: G ::: ~.?r' trO+x Fr`i='-' j7 ~ ~~i ; IJ~(./ :r:bN <br /> .'~ 1, U i. ': f v i! .7 5 5 V A L E REQUIREMENT <br />i:: ~ :( <br />A <br />T /! ?r F' T u <br /> .... i '.~ : ~ -. t. ?.._ L c d ~. I. ~' SAMPLE .. .- - ... .. r. ..` <br />-~ ( 51 <br /> MEASUREMENT ~ <br /> ~~', ] i! :) .PERMIT to C<'!o?:r ;. +. - ~:. .. :~::v y~P,t~, ~` ' INCF/ IRA j' <br /> <br /> <br />.rrv i :fr~ir ~1i I'' <br />' <br />REQUIREMENT <br /> <br />': J:: <br />' <br /> <br />':LTr'! t"' <br /> <br />f <br /> <br />N1'2TN . <br /> .. <br />f.~: nl. SAMPLE <br />MEASUREMENT .^;rQy4'~ .. .. ~, ;:\ <br />,~ <br />~~ / ( '~I) <br /> ~ t.; 1 <br />i ~ <br /> IiJ+`~ 1 U U PERMIT g::;.: rYRC;. :. :pt? 4•:.. tyc }.., J,v rail <br />~ 'S'"~/ :!{di <br /> <br />1r:.uc~T -I 3E REQUIREMENT <br />>:,., . <br />,. <br />!:sTr'r <br />rl <br />-~. ',r <br /> .i. A,'rU .;k ~ i - SAMPLE :'.+C: ;: ~ ' .ft4.,: ...: / ~1) <br /> MEASUREMENT <br /> .7jb2 J U ~i 'PERMIT ~ is .;, ry. <: ): :',: <br />. .:; is :,; :,. :}::4r.^, ~{+ ')':t I tin is <br /> i P L U c ?. f . ; '/:; .: V ': i, '. - REQUIREMENT ,. r,.r...T r v w. r. •: . , , <br /> 'LJN~ I~ ~.,.":-'r.' ~~~~ SAMPLE ( Q3) ..... ~r7;- .. .....::~:p:: <br /> =,`VI J, ;. ,._ - - i, L A ,. r MEASUREMENT <br /> „) ~ ~~ /i L ,^. 1 PERMIT + <br />- <br />~ : ~ T <br />.: •: ::: <br />C :.. .. ~ - <br /> .i':': i i.; .. F. )c• ~ YA.LU? '~REOUIREMENT 3i)-~ LVG !)-+I'. i "" <br /> .~~, ITn I. SAMPLE r: :;:• ... i:. -. ~ ]') <br /> ., :.Y r.v MEASUREMENT <br /> /~,. ~~ 1 1 1 PERMIT ";c .':f :%<: Ci .^,; xit ra t:c{:r C:rG {: ..~:.: ;::}rr ;, n <br /> .. ,; :: Y : , F J ~ ~~ ~ f L ~ ". AEQUIREMENT r. 9 i i. n Y '- / ). <br /> NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD <br />AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON <br />~ ~~ TELEPHONE DATE <br /> <br />MY INQUIRY OF TNOSE IMDINDUALS IMMEDIATELY RESPONSIBLE FOR . <br /> <br />~ <br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />MTE <br />T T <br />TE <br />I <br />T 't <br />''I <br />' <br /> _ TRUE. ACCU <br />AND COMRE <br />. <br />AM AWME <br />HA <br />HERE ME <br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING , <br />~1 ~ ~ <br />~ r f <br />~' ~ l / <br /> <br />)/, <br />1 ' <br />~ <br />~ <br />, <br />1 <br />~ <br />~~ <br />~ <br />) ~ ~ ~~~ <br />r <br />/ ~ <br /> ~ <br />. <br />.. ' <br />. IU THE POSSIBWTY OF RNE MD IMPNBONMENT. BEE 1B U.S.C. f <br />001 MD ]] <br />- 610NATURE OF PIIINgPAL EXECUTNE <br />- <br /> ~ U.B.C. ! 1]10. IPaWeln rrOV FS,r, wNh, nI,Y M+cM.d, rvw, y ro 510,000 AREA <br /> TYPED OR PRINTED I sns ormui~...,.rhw%srwlrrtwan.wrsmo-tn, sods Y.va/ OFFICER OR AUTHURI2EO AGENT CODE NUMBER YEAR MO DqV <br />GVMMLn I a g1YU CArLg1Rq 1IVn yr nor YI+/Lq I tuna tnsrsimcs rvr truacnnrsma nqe/ <br />._..! LE$3Li. SOLI;,- L;"j. .._... ~L: T..F C= .-y ~.~ :I'-.. .....:, .Yt.,,. i`' ~i tI°.- :°' .. 2*' ,:''~ •y <br />T:iS ?% II•:)', L. :! ... ..L ~rJ'i ~F. 4i'CL:.(i, "iJ ::r:ihP.':i •~ - <br /> <br />EPA Form 3320=1'108.961 'Prevlo5^ adltlons'mey ba used. t ~ (REPLACES EPA FORM T-40 WHICN MAY NOT BE USED.1 PAGE OF <br /> • <br />/r <br />