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PERMITTEE NAME/ADDRESSp I,6 FxY/ry N.wL«nlw l/Dlpwn.D <br />NAME TRAP/i: b' tI II ~.;, :'.'„ <br />ADDRESS T k A i' F' S ;; '? ~( ~,r <br />i'.0. r0'{ 1~7 <br />CHAILi i;'J i41L2r~ <br />FACILITY <br />LOCATION <br />r.:l'i+: w, L,UNU•i'+ Pf:TF.F`~, PkL:S/GEK 9~R <br />NATIONAL POLLUTMT DISCHMOEELIMINATON SYSTEM (NP(IESI <br />DISCHARGE MONITORMI6 REP01E7 (OMR) <br />1-I8/ 17-191 <br />cnuo3zlls cl- A <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO _ <br />/1Q111 /11-131 /14151 I]6-]71 /]A-]91 /30.3/1 <br />Form APProved. <br />P O N C T C C E E R , U L COMB No. 2040-oooa <br />(S D E f. ! N) ApprovelLa~p~rPA;05-31-98 <br />F - FIlPI <br />NIt.CP. <br />044 4C GL~CNA~tOF. ~ ;': <br />NOTE: Rsed ImWetloru 6sfer )eomDlsEinO.thM form. <br />PARAMETER !3 GrO Onlyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> Is8-591 !54611 138-/5 !15.53 15461) OF <br />l32-371 EX MALr515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /e]-sal Iµ881 !63701 <br />'.: l,n Air' SAMPLE ''s~#;, rf .;~ ( Ql'~ •1A04~5 >~ OXOit Id ++. 4f,C'~SF4 <br />r I o U A L MEASUREMENT <br />;:4U66 1 0 U : PERMIT. ~ >~;3+. ~;cg ... . .R~Fi•:~Q~{.'(' .: YS=1 -- ~F+~A4:>(t~~F~.: ~0~10 >D~~L10~! ~~ .4fifrt. t<~., L14v: :. e• <br />-BrL <br />pTSUA <br />:,FFLUF.NT GROSi YALU :REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />~~ <br />~ ~ ~ ~ ^ <br /> . ,;., ::,,::.~.... ..... :...:::. ~ .. <br /> <br />~~.... <br />;: <br />.. <br /> . PERMIT <br />REQUIREMENT :.~ ..::s~~:: .: .~:':: :.: <br /> SAMPLE <br /> MEASUREMENT ~ /~~ ~E~I~~G~ ~ - <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 />~ <br />~ <br />~~ ~~ .. . .. ~~ <br /> :REQUIREMENT .: ~ ~ <br />~ ~ ~ ~ ~ ~ ~ ~ ~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 cl[RnFV UNDER PEN/LLTr or <br />AM FAMILIM WITH THE INFO uw THAT I NAVE PERSONN.Lr ExAMweD MD <br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR ~/ ,,,/// <br />W. GO LdOII P~CaIB OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS ~` ~ ~~fL"-~- <br />_ <br /> TRUE, ACCUMTE MD C01A0.ETE. 1 AM AWME THAT THERE ME / <br />P <br />id <br />t 6 G <br />l M SIGNIFICMT PENILLTIES FOR SUBMITTING fN <br />SE INFORMATION <br />INCLUDING <br />res <br />en <br />anara <br />aas er <br />8 , <br />. <br />THE POSSIBILITY OF flNE MD IMPRISONMENT <br />SEE 10 U <br />S <br />C <br />f 1001 MD G7 7O 824-4401 99 1 <br />ZS <br /> . <br />. <br />. <br />. <br />U <br />s <br />C <br />E 1]10 <br />IMWb <br />U <br />h <br />F <br />J iIONATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRMITED . <br />. <br />. <br />. <br />, uVr <br />wr rbnm, •nrY <br />ckw <br />in„ w ro <br />lO,GOO <br />rdnrmu:m.n innionrlwnr P/Mnrwr6m,nul, rg6y,r,.1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />l.vmmcn I a nnu cnrlwnn nvn yr nn ~ •,vLn „vna Invl/IOLI e1I IneLI1IIIIn~J nlr~/ <br />i -i :i t: 70TAL IHOV LIlIITS PILL 5F. YAIYLD, A9D SETTLE AEtLF. 30L ICS LICIT AFELIED FCF <-l0YR, 2bHR ?REL;IP FYENI- <br />iEE: E.UHLEN OF PROOF_RE4UIRFMENTS UNDER I.A.3. TDS HDYITORING - I.R.3. OIL £ GF£ASF. - til?E I, 9, 1,(D), <br />_ ~:- <br />mey De used. /REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 . O ~ 11 6 /'~ 7 1 21 1- 1 61A ~ PAGE lOF <br />2 <br />