Laserfiche WebLink
PERMITTEE NAMEIADDRE55 pnJr4 FsWry N~/Lor•non 1/D~w.m) <br />NSME <br />ADDRESS ,- <br />r • ) • <br />FACILITY ~ ~- ~~ . <br />LocnnoN <br />NATIONAL P04UTMT DISCHMGE ELIMINATION 9VSTFM (NPDESI • ..GG:.;='--- <br />DISCHARGE MONITORING REPORT IDMRI .OMB,No. 2040-0004 <br />1-16/ p7-19 "' - - - <br />_ , _ I ~( -.) Approve(axpires 05-31-98 <br />PERMIT NUMBER DISCHMGENUMBFA _ -; <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ .. TO -, ~ - I __ I ., . . <br />vo.~n nazm n~.~sl r~s3n na_~m ran.all NOTE: Raed IneTructlolr before Cbmpletinp thb fam. <br />PARAMETER l3 Ord Onlyl QUANTITY OR LOADING !I bid Onhl QUANTITY OR CONCENTRATION NO. FAEDUENCY SAMPLE <br /> !O&531 /54-8II !.~-~5/ IOB-53 15481 E OF <br />/3I-371 X <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS IFIdTI !Bq-BBI !B&701 <br />' SAMPLE • <br />' <br />_ .- . <br />t ... ~ <br />~ <br />~ - <br /> <br />,. r, .. MEASUREMENT <br />- .PERMIT ~ . ~ .. - ~ , coin i, . - I - ~ . .. ..~ c.,.. .. ..~ '~ ~ > I' /; <br /> REQUIREMENT <br /> TP <br /> <br />j SAMPLE <br />MEASUREMENT <br />~ <br /> PERMIT <br /> REQUIREMENT ~ ~ ~ ~~ <br /> SAMPLE <br />~ <br />/ <br /> MEASUREMENT 1 O ~! <br />~~~{.~ <br /> PERMIT <br /> .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~PEflM1T ~ ~ ~~ <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 />NAME/TTTLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEMKT' OF LAW THAT I NAVE PERSONALLY EXAMINED AND <br />AM FAMILIM WITH THE INFORMATION BVBMITTED HEREIN: AND BASED ON - '~ .j TELEPHONE DATE <br />~ <br />II MY INOLXRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONBIBLE FOR ~ / <br />n <br />-- <br />r, ~ I ~ V I ~ I (? l) a I OBTNNINO THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ <br />` <br />- I <br />~ <br />TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIONIFICMT PFNALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ ~ <br />/ .` it- <br />~ <br />~~n <br />1 ~•. ` ~. I ~ r I~I t , <br />THE POSSIBIUT' OF RNE MD IMPRISONMENT. SEE le O.S.C. f 1001 AND 33 <br />BIONpTURE OF PRINCIPAL EXECUTIVE ~ <br />7il ~ ~~ <br />S ~- i l' ~ ~/t ~, <br /> U.S.C. E 1310. fPNrlds ~WY F1•a• •YATIS m•Y arluM Fn•s Lp ro S IO,p00 <br />TYPED OR PRINTED .nI nmuMvn Mlpdoml•nr wMfw«n 6nimeh•W 6 y.•rs.l OFFICER OR 4UTNORIIED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA !ION OF• ANT vwtA I Ivrvs Irterersncs en ertscnmsnrs nsre/ <br />EPA Forffi 3320.7 108=96) Prsviour editions mey be uses!. ~ ' (REPL'ACEB EPA FORM T-40 WHICH MAY NOT BE USED:! ~ ~ ` • ~ • _ PgGE OF <br />