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p£RMITTEE NAME/ADDRESS RrAi6 ir0~ryNaw/ncnlw dD+pi,w,q <br />NAME '~ L ~ - <br />ADDRESS' t ' <br />1 • • , <br />v .., ~ I 1 <br />FACILITY <br />Li7E:A l i0N .. _ , <br />, - f. <br />NATIONK POLLUTANT DISCHMOf ELIMINATION SYSTEM /NPoESI FOIT APPlOVed. <br />DISCHARGE MONITORING REPORT lOMRI r- . O B.No 2040-0004 , <br />lI-Ibl 17-191 i' 71i u i i ~~ I r,n ~. l <br />" ~ ^, ~S 5 ~ .^ ~i / (', r ;.. ~{ ; j APPravel exPirae OS-31-98 <br />.PERMIT NUMBER DISCHMGE NUMBER _ <br />MONITORING PERIOD ~ ~ ' <br />YEAR MO DAY YEAR MO DAV <br />FROMI I I I "' I ~ I - I - I - ' __' ' <br />110-111 /I2-231 !14751 176171 I7B-191 I36J1/ NOTE: R~~d In~trucliwu Mfon compl~Einp thu form. <br />PARAMETER z !3 Grd On/Yl QUANTITY OR LOADING le Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> !46531 lye-6!/ !3B-e5l Id65J1 /5e-671 of <br />131-37I EX ANALVSS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 16=.6,71 15e-5B1 169-701 <br /> SAMPLE <br />Y ! <br />' I <br /> MEASUREMENT B,1 `;,1 . CI ;~'! 117 v, <br />' ~ ~ - PERMIT .... ~ ... ~+ . :, .- .. <br />~ ~ .. .. r .. <br />- .' .. ~ - REQUIREMENT ... " [ n: +S i T - ~. , I, <br />. ~ ' i. ' .. <br />r SAMPLE ... .~ : ~ ~ .. ~. , -.. ... ..... ~. <br />( j <br /> MEASUREMENT 0 0 1~~ dTab <br /> PERMIT ..... r~-r2~i. ..~,.rY <br />.... <br />Y, '< <br /> <br />1~.5 <br /> <br />it C; '7_' <br />:. ... , ^ I S -; 'J ' ~~ <br />... REQUIREMENT = <br />::Y D A 7 L Y `: ~' '• i. / I. ` ~, P: (~? <br />..+ ~ i': d. ;. SAMPLE .- ... ;1 <br />( <br /> MEASUREMENT 0 O ].~7 GSBh <br />.. J PERMIT ... - ~ .. - ~ . .. <br />... j !:~ ! ~ r Y Y :;{ ! - <br />.. ,' .. % :. ~ p : g ~ ~ - REQUIREMENT Ilb :. ..: ar 17_ '..T <br />+. F + .. J ] SAMPLE ( i 1 ~ . <br /> MEASUREMENT 0,115 !),llr O ~.~9 IriF-t, <br />.• 1 J <br />- . PERMIT ~I'i~i~4aL ~.'~' +~: ~:-: ~.:. .: ::: .,. ::: 4. ~;::[:::y.:: (. ~ :":~ -. r .I.... <br />....:'+I' ,~ J.~ REQUIREMENT 37L.t .A itv ~ L? i <br />~' <br />, <br />:~ .: _+ , J C 1 ~. SAMPLE ~. r .. ( <br />% ~,) <br />. MEASUREMENT ~ (i ]~% ,j.;~„ <br />L ~- PERMIT .:g,., ":PJiT 7 i_! ~.9;.. ... .r. ! <br />- <br />.. .' i .; .i J REQUIREMENT ~': ~ ~ K n'' _ ) ..: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I NAVE PERSONALLY EXAMINED MD <br />AM FMOLIM WITH THE INFORMAl10N SUBMITTED HEREIN <br />MD BASED ON -" _ / <br />-" <br />i~ TELEPHONE DATE <br /> : <br />MY INQUIRY OF TNOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOR- ~ <br />~ <br /> <br />L ' <br />/ <br />_ <br />,iSCI~{Z'fj ;~. LLlIL Ui' OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 15 <br />TRUE <br />I M1 AWME T <br />ACCURATE MD COMPLETE <br />T THER <br />RF ~ <br />~ / //~I I <br />` <br />' <br />~ <br />' <br />• <br />t- <br />* <br />' <br />' <br />LCO ~ <br />1 <br />I <br />t <br />' , <br />. <br />HA <br />E A <br />- <br />91GNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING -~r <br />~--- <br />- i <br />( <br />~.~ <br />r <br />( <br />.A r~ <br />' <br />(1 ' <br />' <br />~ <br />( <br />^ 1! I ~! <br />, <br />( <br />E;n <br />e!i <br />1 , <br />THE POSSIBILITY OF NNE MD IMPRI <br />MENT <br />S <br />1001 <br />O <br />EE <br />6 U <br />~ , ~ <br />J <br />_ <br />; <br />~1 <br />I ( ( I <br />- <br /> . S <br />.C. 1 <br />S <br />N <br />I <br />. <br />MD 77 <br />' bIDNATURE Of PRINdPAL EXEdJTRFE <br /> u.S.C. 1 t 71Y. liM,M4, uWFr fhFAr mroNa m.Y Ncp.W /Lw. w ro i 10,000 , AREA <br />TYPED OR PRINTED Anew muinun MP+Iau~mFrItWMl,rwn 6mmMFAM6y~FrF.1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />I:VMMCn I a grvu [nrlgnn I wrv ur nn r vlvL.q I was Inerelenco sn J/TlecnmBOO natal ' <br />EPP Form 3320-1 108-95) Prsvlous edluone may be used. (REPLACES EPA FORM 7.40 WHICH MAY NOT BE USED.) PgGE . OF <br />i -. <br />