Laserfiche WebLink
~ 1~ i <br />rfnmi i tei nwml:IwuOR[55 (Iwrr PrIBryNOw/loc,um eD1p,.w,p <br />NAME <br />ADDRESS :?'.' 7 i 'i ". .. 1 ., , , ~ I ;u' <br />t~', ILl •114' <br />FACam ` , <br />_. a ~. _ .. ~ i '-.. r. <br />LOCATION <br />' ~C t <br />V C f.: O -' <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION ST51'fm iir'r'.:evr <br />DISCHARGE MONITORING REPORT (OMRJ <br />!1.161 /I7-191 <br />.-l;~i~ .;a~ <br />PERMIT NUMBER DISCNMOE NUMBFA <br />MONRORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ) ~, -. 1 ~~ t TO : a, i ~ t <br />(20.111 !IT-231 I1LT51 lT6TTI OB-T 91 13rA3fl <br />Form Approvaeel. <br />d. :".I?:: 1F..A ?~ P,OMB,;flly ~.: 11~agg~KK <br />dpprove s ro 0~=3T?J8 <br />!'~ 1 :' A L <br />• 1: r <br />t, <br />NOTE:/ RssA Instrueaons G1or! eomoletlna this form. <br />PARAMETER !3 Gre OnlYl QUANTITY OR LOADING !1 Grd Onhl QUANTITY OR CONCENTRATION ND FREDUENCY SAMPLE <br />/~ J7! 146-531 !566/1 /38451 !4653 !64-61 OF <br /> EX S <br />YS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rcT-sal t <br />AN,u <br />(66681 !6s-)Of <br />{ SAMPLE <br />~ ~ <br />~ ~ ~ ~ ~ <br />~ <br />~ ~ ~ ~ ( -, ~ I I • <br />/ <br /> MEASUREMENT • Z U • ~ ~ I r . <br />~ ~I .. •.; C ., ., PERMIT ., f.....YZ.T xScfA#=` ~` X >'. ~ ~. '% #'~~{~ .-~ <br />~ '3 . J ~ . ~ a v <br />"`~.`? Y r <br />L~i1 ~':I .' <br />.. <br />. . REQUIREMENT - <br />F <br />t E 'TM N . <br /> <br />~. )~.t l; :~, zlrn 1. SAMPLE <br />..... <br />.,., ;::t;: <br />r i-) <br /> <br />Ir ::u J.:,l <br /> <br />MEASUREMENT 2(~ 2CA U ~ GF <br />.,~`-.iJ 0 <br />~, ~ PERMIT. ,.:~~r..; r,:z?t~~•°,s r, ~i-;:~en:t# 1S ~ ~ 7C ~ k~:i~~/~:~ >°d$~.~. <br />.: t• , ~ ; I ~ ~' r : a r. REQUIREMENT <br />a . <br />`I . a• <br /> <br />., <br />R <br />~~ <br />. <br />,: m - ~ ,;, <br />.: J v i G:i . ., ... T l.'. SAMPLE ..:.......:.:. <br />~ ~ ~ ..,..,,, ..;.; ,, <br />~ :.:..r ,._.. ,_ <br />~ ~ ,,) <br />( <br /> MEASUREMENT ~ ~J ~Q <br />:; ~.; _: 1-. 1 0 PERMIT <br />~ ,:.:S Kt Tt~ =kt+~Aki,: Cz t :?. ~{c e;aa##": .'r i.. i <br />I'`7 R L ~a~ ~ <br />r <br />:!'. ^~: <br />f ~I <br />J <br />;)3~A 9~ <br />w~~v' fl~;•~ V REOUIREMENT ~ <br />3 '1A .}V'" .. <br />aA iY " ~'/L :... <br />. <br />4~.t%:u . <br />".i4r '"l):'r1s SAMPLE .. .~`I: r'-'~ ( 1 )) <br />(A i F " 1 MEASUREMENT -~ I I ~ ~ (A / <br />i J A ~ 1 ~ PERMIT .~ Y-,,,,. <br />'r:F:t:. <br />.. .tA:;: ;: it <br />-e..~ . <br />7'. .,~ <br />4-'>J <br />'~~A. i' <br />;-, <br />:t~ r H ~.- V:I :.~I <br />~. ., REQUIREMENT <br />.-- 3i~~ h4" C?rl ~~.,q ~H 1E .. ;lt ,I.)t m. <br />' f t, ~~': '~Rr. ,~ .. SAMPLE <br />MEASUREMENT ,. ..:. ,,_.. <br />~ :. ....:.:.:. <br />~ :. .. ,.:... ,. <br />f ~ ~ <br />~ <br />~~ 1 I) <br />( <br />~ ~~_n n // <br />'.,1Z ~N <br />~i 1 C ~ PERMIT ... ,... ;o •'.'. s. n '" ,. :~~:: .c tic .. <br />,\ A9 <br />F 1 ~ v' S 4;'' ~ _- •. I <br />, REQUIREMENT ,. .,-.. ~ '7 `i. 1 . },~g~8 ; 1 L ~ T <br />. <br />~,. <br />~'!. ~., C`I C.J 1, It I,. SAMPLE ( ~;-;) A <br />... ... <br />~ .,..... <br />• I <br />Tdt:E9'° s m .. MEASUREMENT r /)' l~ ~ _ <br />I J~) <br />Z- O <br />'i L (~ ,i <br />• PERMIT ..: i'O';~r i <br />"I <br />I ~' ~:y - <br />~x :~ . <br />:~ <br />~ <br />~ ~~.. V v <br />I <br />~ _. <br />: <br />4 <br />~ _ .. ~ . <br />. . <br />, <br />. <br />... ... <br />I ~ U <br />,TS <br />L(,1 ::4: .n ~:.J <br />' REQUIREMENT ~li L^. f1 ~Y Yir ,Y -0.J yY rv•`t <br />. <br />.. <br />1~1U~r 'TV";ij, <br />, <br />:~ I; `• 7 L V `': J SAMPLE <br />MEASUREMENT ..:... .:..,. ~ ..'.:r.:y / <br />~' V ' <br />I~ 1 ( <br />1 /) <br /> <br />U I <br /> <br />~~c, <br /> <br />'1KPh <br />~(v ~ i.J 1 !` PERMIT •::>,+.'s4#-'t.:j ::::~w/.;x ;'f Ct ti;pr ~+`w y::. '~ t' x ~ i. :.~Y c! <br />. °r LIJ r; I-f ,;';t . ~ '/ 1 REQUIREMENT ~ ~ ~ .. ~ Q? ~ n'J~J. ;'!{:'t ". h~S 'r ~;/ ~.. <br />NAMEli1TLE PRINCIPAL EXECUTIVE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF lAW THAT 1 HAVE PERSONALLY E%AMINFD MID <br />MILIM MATH THE INFORMATION SUBMITTED HEREIN <br />Mb BASED ON ~ I -) TELEPHONE DATE <br />1/p 1 I !r <br />~ I ~ <br />~ ; <br />MY INQUIRY OF THOSE INOINOUALS IMMWIATFLY RESPON9BLE FOR : ~ ,~ ~, <br />t E <br />I <br />t \ Y 1+ Y] <br />( OBTMNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 15 <br />TRUE, ACCUMTE MD COMRETE. I AN1 AWME THAT THERE ME <br />5lGNIFCANT PENALTIES FOR 6UBMITTINO FALSE INFORMATION <br />INCLUDING : ~ ~% / <br />, y ~ `I <br />1 ~ . ~ d F~'. f\ , <br />THE POSSIBNTY OF RNE MD IMPRISONMENT. SEE is U.S.C. 1 1001 AND 33 <br />s <br />c <br />1 tats <br />/1M,rBF.. ulr <br />U <br />M <br />osur <br />Y <br />hd <br />r <br />sro <br />a <br />SIGNATURE Of PRINCH'AL EXECUTIVE / ,'U 1, ~ ~lI l -~ / ~. <br /> <br />TYPED 011 PRINTED . <br />. <br />. <br />. <br />r <br />r . <br />A nnr <br />t <br />A <br />vNAw ro <br />, <br />o <br />nls armvim.n hMN.a+v.wNa/b.nrw <br />s <br />s <br />W6 <br />/ <br />OFFlCE <br />T AREA <br />NUMBER <br /> n <br />mm <br />u <br />Fwa R OR AU <br />HORIZED AGENT CODE YEAR MO DAY <br />Vv.m.a•V ( ter, L ~~, •~ i~'..vo I, L •.. r ., ~ ....`, i vv, o, nu~r V r.-'..mC mn~ ., e~.r F ~ { ." f \, i !' . Y ~ - ~ I. f` { ...1 • ~:?. ~ ~ I 1 ~ <br />.. <br />. . °. .. ;, 4'i ..T i ~,i::!. .'1'i 1,I ..I .. i• ~,.I-, ~ ~`) '~ .~ ~. I',- i. ., ~ I . ,.. , <br />', <br />_ r <br />EPJ1 Form` 320=1 08- 1 PrbJious eAitiorie mey"6a used. - IREPLACES'EPA F Td0 WHICH MAY'NOT BE US1:D' PAGE OF <br />