Laserfiche WebLink
FERMITTEE NAME/ADDRESS p,tb4 Fralry Nw/Leea,lm IJD~.,nr) <br />NAME II„ ; Y c ;, . - ~ ~ 1 i } :, <br />.. MTIONAL POLLUTMT DISCHMOE ELIMINATON SYSTEM (/yI'r%!J`/ <br />DISCHARGE MONITORING REPORT lOMRI <br />ADDRESS fiU+L '.J <br />' ,- i .':51 "!I4~S 0'0)3355 C 1 <br />, ~ , ;; , R _'..{ i G PERMIT NUMBER pSCNMGE NUMBER <br /> <br />FACILITY k' J~ i d <br />~ j ~ t ., ~ c' ; t (' J~ 1 U` ~ <br />~. "ri .. _ ..: 7 h" ~ MONITORING PERIOD <br />VEAR MO DAY YEAR MO DAY <br />LOCATION FROM 1 '. I :~. TO '+. ) <br />i _ ..:.LT.~ ,,. un ., ;,:•'. nmrl nz~m vuRl vrc~n vaaal r3nsu <br />(j1: 'td r C) <br />T!J ;•, <br />:~~: •. A~ rtoved. <br />T ~ 9M@ pa. ~340:P8e4~ i1 <br />APProvel Yxfiie~ $6-31-98 <br />I11 } <br />NOTE: Hud Instruetlons bslore complstinp thb foRn. -' I <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING (1 urd Onlyl OUANTITY OR CONCENTRATION 1,10, fREOUENCY SAMPLE <br /> ld6531 l5d-6I !38-15 ld653 !61-61 <br />EX OF <br />TYPE <br />l31-371 Muvsts <br /> AVERAGE MAXIMUM UNI75 MINIMUM AVERAGE MAXIMUM UNITS rd~-6sl !5d-se/ l59-701 <br />!1L hND (- iF A'~~F SAMPLE 3C:. ;: .Y ~( '14) ~.. . ?c: t:`~; .. , <br />i 1 _> d h i, MEASUREMENT <br />~su~: ~, 1_ i f n PERMIT ..:ar c u:`. Q~~PCTum c ,c, ."'. .t ~O g~: >F !t {:x0_~ ~~ ~.'v';::-:^~$. .. F£?, R. L~ VI i.4 <br />'?Fi.U.'..,T :li0i'S VAI.~. REQUIREMENT ~ TN~ST~ i"AK '~~~=C ~ . <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ . ~ ~ ~ .. ..... ~ . .. <br /> REQUIREMENT ~ ~ ' <br /> SAMPLE ~ ) <br /> MEASUREMENT () ,~7 ~ <br />=-C ~ I'I j( L° <br /> .PERMIT <br /> REQUIREMENT ~~ <br /> SAMPLE <br />~ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ .. ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ <br />~ ~ ~ <br />~ ~ ~ ~ - ~ ...~ <br />~~ <br /> 'REQUIREMENT ~ <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ .. <br /> REGUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT -~ ~ - <br />NAME/i1TLE PRINCIPAL EXECVTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED MD <br />AM FAMILIM WITH THE INFORMATION SVBMITTED HEREIN; MD BASED ON - ~ <br />/I TELEPHONE DATE <br />/~ 11 II^ <br />~~C 1T !` -j 1 r' ~l'.2 MY INOUIRV OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFOMIATION. I GRIEVE THE SUBMITTED INFORMATIOE IS - / / i <br />/ / <br />J ///%~ <br /> TRUE, ACCUMTE MD COMRETE. I AM AWME THAT THERE ME <br />SIGNINCMT PENALTIES FOR SUBMITTING FALSE INFORMATON <br />INCLUDING ~ <br />~~~/// <br />(' : ' <br />~ ~'I~:: I ~ ~ I ~ <br />U , <br />THE POSSIBILITY OF NNE MD IMFWSONMFNi. SEE 1B U. S.C, 1 1001 MD 13 BN7NATEME OF PRINd-AL EXECUTNE LI ,~ 5 <br />~~ ~ll ~ ' ~~ I `l <br /> u.s.c. E I GI s. rawlN, uldr dnw mnm, m,r IneA.alr r,r. w m s ro,aGD <br />TYPED OR PRINTED ra nmuinun l.wls+rlavN Pr an+wnanlw,wwsrwra/ OFFlCER OR AUTHOR2ED AOEMT CODE NUMBER YEAR MO DAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS IRelrrencs en ettschmants Aaral <br />. - ... <br />1. - •. 1 I' C ',Y li i C.O;:r r C r .. ..r 4. _ t , • ,v - V <br />r ~. <br />y I L' -i _ ~' ~I Y .G'r?: Tt TA'~T `I I: ~' -T. J ,% <br />EPA Form 3320-1 108-96) Previous edltiona mey ba used. (REPLACES FPA^FORM T40 WHICH MAY NOT BE USED.)' - - • _ PAGE OF <br />