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PERMITTEE NAME/ADDRESS p.rrLfewry NaWLacm/u+UDr)fwnrp <br />NAME (i lv).' ~ '. =. i'1 Ji.;:-7 r.":'1 r.ii <br />ADDRESS r : w' i ' .' ° .. ~ .1 ' - ? M r. ° ": i <br />FACILITY <br />.)M: . ~ '' i'~Il .~i <br />LOCATON <br />NATIONAL POLLUTANT DtSCMAROE ELIMINATION efi'i Em 77 °S: <br />DISCHARGE MONITORING REPORT lDMR1r~V~ <br />/?-161 17-191 <br />"null AFC ~; <br />PERMIT NUMBER DISCNARDE NUMeEfl <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ,+ 1 ~ -• ~ TO "t ^. ~. ~ ~ t <br />Ohffl 0)_)31 tlLJ51 /)B-l JI !)A-0AI 13Q311 <br />Fonn Appr~joPveO. <br />OMQ.J~q~ k 0~-000A <br />r I~ l I p c a ~ n cllppro el ~~3ree 05=3'1 X98 <br />( - 111E I' <br />NOTE: ~ Raedr Inetruetiala~befori L<ofipbtinp thb form. <br />PARAMETER l3 o.d Onlyl QUANTITY OR LOADING !4 Grd only! QUANTITY OR CONCENTRATION NQ. FAEDUENCY SAMPLE <br /> 146531 f5d-611 !3845/ (06-53 (54-61 <br />EX OF <br />T <br />l3S-37/ AN,uras YPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /s)-sal (64681 (69-701 <br />. At,.i ~~ SAMPLE ... ,-... / ( 1i4) ;='3#==.: ~.? .-. C- <br /> <br />MEASUREMENT ~ <br />C ~ U - AI <br />J <br />~ L 1.4 <br />. <br />~I ~!I i~ i . ~ ~ PERMIT ~~~ .. _~--'4.::: ~? ;tt~ri? i.:~=1 E: ..Z V.;=~ ~:;s l"v ~.;- ~~: .:.Sx,),; ~a .. 2'~ I,Y f ~" I'nf <br />.l ~~ <br />_ REQUIREMENT ~ <br />,1 ,: ~ T _I= <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ .. ~ ~ ~ .: . <br /> REQUIREMENT. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />. ~: ~ PERMIT ~ ~ . <br /> ;REQUIBEMENT <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 /> 1 <br />NAMElTI'TLE PRINCIPAL EXECUTIVE OFFICER 1 cEflnFV uNDEfl PENALTY of uw THAT I NAPE PERSONAUr ExAMINED AND <br />AM FAMIUM WITH THE INFORMATION SUBMITTED HEAEIN; AND BASED DN i / ~ j <br />~ / TELEPHONE DATE <br /> NeI <br />M <br />T <br />Y <br />ES <br />E ' <br />/ <br />1. P ~ l I" S l f ~ r ~!Z MY INQUIRY OF THOSE INDIVIDUALS IM <br />EDIA <br />EL <br />fl <br />PO <br />BL <br />FOR <br />OBTNNINO THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IS '' ~ ~ <br />/ <br />!j- I <br />~ <br />f TRUE. ACCUMTE AND COMPLETE. I MI AWARE THAT THERE ME <br />BIONIRCANT PFNIV <br />TIEB FOfl SUBMITTING FKBE INFORMATION <br />INCLUDING ~~, f <br />Q~L <br />/~ <br />F . I <br />e <br />1 , <br />. <br />~ ~1 ~ ,r <br />T -' <br />~~I <br />j~ _ <br />' <br />I <br />( <br />l/ <br />l THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE tB U.S.C. ! 1001 AND 3] <br />61GNATURE OF PRINCMAL EXECUTNE / 7d <br />l ! /; <br />; <br /> <br />TYPED OR PRINTED U.S.C. s ta10. IArWtl++uWr enw mam+m+r hrJUy+ rvr+lq ro tf0,000 <br />+nyn mulnNn mrpio.+u++we.+r++A+smmnr. nleByw~1 <br />OfFlCER OR AUfHORIZEO AGENT gREA <br />CODE <br />NUMFIER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reverence en ettecnmenrs here! <br />L.°i9L ...., ... ~ ..: 'r.i ..-: 1.. is ~='. .i'; ',',J i": I' `.V; _ ..1 ~.`.. y.Tr p. ',Vf~l ~ ~ ~_' <br />. . <br />~ <br />..i., ., ITC' . L I .. ':' J i L„ :,.~-( ? , ;~', T '' n - - ... : A' .. . - _ .. ', ", . ., - -t: -~ <br />I : ~ <br />FDA Form 3320.1 08-95) Previour sEiudn4 mey be uedtl. ' ' • ' r (REPLACES A FORM T 0 WHICH MAY NibT BE U8ED:1 ~ ` ~ ' ~ ~ PAGE OF <br />~ ' ' ~ ~. <br /> - <br />