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I~' <br />PERMITTEE NAME/ADDRESS (lri,dr FxWry Nn,Wlecanan 1lDr)lnrn) <br />NAME JJ~jG !iL~i J,l4: ",i, Lla1I':. l) <br />ADDRESS H J .I L G R) . Z ' I ~! E: <br />P.u. I~)x a~3J <br />PAJVCA ;: .J 9111.• <br />FACILITY -1'J.li., I'F,J)'rR_GJF LI•:IC~'•L <br />LOCATON <br />NATIONAL POILUTANi DISCNAROF ELIMINATION SYSTEM INPOES) <br />DISCHARGE MONITORING REPORT lOMRI <br />11-161 117-191 <br />-a rn <br />^ PERMIT NUMBER DIBCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM / ;S '%1 J L TO 'i ~ i <br />/16171 /17-?31 /1d-15/ 17617/ /18-191 /36311 <br />?'JNA C U5:6~; ; <br />(s:rt it a:a <br />F - F'I`!AL <br />"INDR <br />FOoOrmp Approved. <br />rTMRNO4~Qt1,~,-~~ r <br />Approval s><plrae'l~I ~-98 -~i <br />I73R5 <br />• ,R df SLIIF Hari ~ 1 :... .. <br />NOTE: •e netruceone ~bs or eompletina Lhb form. <br />PARAMETER !3 Grd Only! QUANTITY OR LOADING !I Ord On1Y1 QUANTITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> !4653/ 15d-511 13BJ51 1db53 lSb5E1 <br />EX OF <br />131-J)1 ANALVas TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS !62.691 !54581 153701 <br />~ K SAMPLE , ,. „ , „ , r , ,- 1 <br />( L <br />1 I <br /> MEASUREMENT S, j ~ ~~ /] ~ ~ ~.~, <br />UViJJ _ ) U PERMIT F".~~h .`-0^w~7 r=tl:: i.3 :?K;wC: ~.U E>3KLY F'vSI;' <br />t E r 'J ~i ~ <br />` REOUIREMENT y T .. r w:l <br />1' <br /> <br />JJLLI ,F LJlt1l. SAMPLE <br />/'•• <br />•„Mf <br />•rf•,~ <br /> <br />1 <br />~ <br />I ~1 1 <br />` <br />/ <br /> <br />~ <br />[ice-; t'c,~~J~J <br />MEASUREMENT <br />Z <br />/~ <br />~I <br />~0 <br />::0'1,J 1 U U PERMIT psP i:. #~C.`,~~ K C: r:r: ,-.... .., )> 70 <br />~ !'_ <br />q..G/ <br />'iiA9 <br /> REOUIREMENT <br />SJLLJ:,, ~;:T!'LRAiL3 SAMPLE ...zX.^- ,.,rf. .. f.. <br />( ~) <br /> MEASUREMENT ~ ' ~ " I U / k] <br />JJ7a7 I i) U PERMIT 1`"•"'Y+'r %f 'a K:v~v.^• .. art:=~:~ .L;.L~~: .`~ !RCE/ ,RA.f <br />c F "r' L Ll ~~i ', !' ;; H 7 ~ ~ V A L ~ e REQUIREMENT r\ ~ . M " / I w <br />Lt:Jr1 <br />!'J:'AL SAMPLE .?:i:;y? (a.',~.;::=': ;: ~. i .1I <br />( <br />, <br />, <br />. MEASUREMENT ! g ~ ~ ~ ~ <br />~ ; _ <br />J <br />I, 1 t <br />Jj /l'. 1 :) ~ PERMIT 4~X t-N~~? ^4Y'X:Kr .. GOYPUv 3.J 6.0 INIT. F"/ ;Aq'-, <br />r' t L J C'l i :; R) 3 3 V Il L J E REQUIREMENT r, n v Mn r <br />JiL Ai•Li :RE6.i` SAMPLE ., .. .. .,. ,-, ~., . . ( 1'J) vi5. <br /> <br />MEASUREMENT ? <br />7 ~ h <br />U.I>:IZ i U J PERMIT kRSYR;Y 4kYv~$ :` ;;:;~ .:-~:Gi=~ ,,.: ¢ <br />L U <br />O td T I u <br />; R A ;1 <br />i'F'1.U c~,? ~R SS VAL'J !' REOUIREMENT <br />~ {: ,t t1 "Y rpf•~ <br />PL i«, j.`' ~~NDJLI JH SAMPLE (031 ^• ~. .. . ~7C .:: ::~K< 1 <br />I'dr;J iLE, .41'MEYP PL4Hr MEASUREMENT .n Z SOI <br />, a / <br />~OJSU 1 U U PERMIT RRPZRT eP,PURT ,;;rk;t;; Kr:kG~ ~ ,f:Cc-4'.:+: :>r::# f:rFLY !1S"ll " <br />' <br />i:FrLU89T ~HJSS YPL,!? REOUIREMENT 30UA ~Y,; D>tI Y 4 ~f <br />50LIUS, T)T4L SAMPLE <br />MEASUREMENT ;:t; ~;{: ,,,;}pa ,.,;Y:XK;r 1n <br />( 1~~ <br />~ <br />J .L ii 5 J L'1 , J l l ~~ / r <br />7U1J5 1 0 3 PERMIT Rk,^•~x' :;=,-r~: `•;t <br />+ :G;r;Y;;.;;: Ne;PO f OFZf;7;-i:ll. TRLY :n4: <br />r' P L U G :':' J R J: 3 u h L l E' REQUIREMENT . .~ ~ y; r <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDFR PENALTY OF LAW THAT I NAVE PERSONALLY E%AMINED AND -- TELEPHONE DATE <br /> AM FAMILIAR WITN THE INFO RMATION SUBMITTED HEREIN; /JIG BASED ON - / ~ ) <br />~ _ _ <br />II <br />~ FI ~N ~ I IO L R MY INOUIRV OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~~ <br />/ <br />// <br /> TRUE. ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ME <br />SIONINCMIi PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING / <br />~/ <br />~ <br /> <br />+~ . <br />P <br />I <br />SEE r <br />B <br />! 100 <br />O <br />E <br />M <br />T <br />U _ <br />r ~ J <br />F <br />; (~ .C. <br />THE <br />pSSIB <br />UTY <br />F NN <br />AND I <br />PRISONMEN <br />. <br />B <br />. <br />1 MID 97 610NATURE OF PRINCIPAL E%ECUTiVE ~ <br />z'/( ~ r, r <br /> <br />TYPED OR PRINTED U.B.C. f 13Ie. l/Ynrltlv uNYr OMr .Arrana mry 1xA.W riwa w ro S 10,000 <br />MNrmuhvn Nrpbn+nnr e7blwr.n6mmrAa rd 6YwA1 <br />OFFICER OR AUEHORI2ED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />COMMENTS AND EAPLANATIVN Ur qNY VIVIq 1lons IHBTBrenCe an srtecnmenT9 nsrel <br />SET1'L6Acf.. ,JLIDS LI"I; 4!>PLiFS ~LLf I:' .= 1J-Yfc, '4-iS ?P;:_ir :.ra.,. I~ '..L',I' .. T.r •.I r ~p~ / r~ <br />L)7'.~J <br />~! f1QCD, 1 <br />c 5.5 ; IRJN LI'7II5 SILL <br />.. . ';JP <br />. jF. APPL[~D ^J flE°Jr'PF.C I.e,;.:..,.T..~:J"? -.,: I I. ' .7 a, ~ /, d,+ I.E.1/;, P;. <br />r PAGE OF <br />