Laserfiche WebLink
PERMITTEE NAME/gDDRE55 (/~bFregNawJlotanm UDrp..wrl <br />NAME ., i <br />ADDRESS ~' ~ ~ ' <br />,'... 1. <br />J , _ ~ <br />FACILITY <br />LOCATION ~ ...., , <br /> <br />NATIONAL POLLUTANT DISCHAItOE ELIMINATION SYSTEM (NPDESI <br />DISCNARGE MONITORING REPORT IOMRI <br />l1-161 I7-191 <br />PERMIT NUMBER OISCNARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM .: 1 ~ , 1 TO 1 ~ ... 1 , ; ( <br />tl/10I1 01J91 OLD51 tlb]71 U8-]91 1363/1 <br />Forrn Approved. <br />•. 'r ..: ; / `, r ; "l ' ~ OtylB~No.~ 2040-0004 ~, <br />Approval expires OS-31-98 <br />j'- ~ ~, i r <br />NOTE: Rud Ilvtructlaa bd«e eompbtinp thb form. <br />PARAMETER !J Grd Onlvl QUANTITY OR LOADING !~ 4rd OnIYI QUANTITY OR CONCENTRATION NQ FREOUENOY SAMPLE <br /> 146531 150-611 !38-45 !9653 !50-611 <br />EX OF <br />TYPE <br />132-371 ANA1Y513 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /sz-sm !µ8g1 !54701 <br /> SAMPLE ~ .. - <br /> MEASUREMENT <br />i PERMIT .. .. ~ ~ . .... a . `, .. ~ p : , I r ~~ ~ <br />.. , ~ REQUIREMENT .... `! f :; :: ~, .: ~ .f: ~ CIJ ,: <br />- i , SAMPLE .. ~ ... .. .. .. , . ( ~ -- ) <br /> MEASUREMENT <br />- _ 1 ~ PERMIT - :r:-r.. ,f. ~~;~~ .. ~v. ~ ., ..- ., ry I 'J :'v- / .TA'. <br />( .: 't ~ , I, J ; REQUIREMENT .~ 7 ~ y :, y <br />./_ <br />): :r <br />- ~ I :, c t. ~ SAMPLE .. ~ ~ ,.. .. .. t I -' ) <br /> MEASUREMENT <br />_ I :i PERMIT .... .. .. ~ . - I :. )': ;" ' ' .~' . <br />~. J ~ ~ L .:..I : i /1 L J ' REQUIREMENT ... j, ` / :. . <br />, L .._I _rJJ?" 7? SAMPLE ( J1 <br />, ~ - `i ;' f L A H :' MEASUREMENT <br />J PERMIT 1P PI38. i~..r:,'i .. <br />. . .,.. ~ <br />.. l '. - ' :~ .' :.: 'i ", ;.: REQUIREMENT J O O A -.. J l ;.:. Tt Y .. •. ~ <br />_ -. n ~ ... SAMPLE ( -' I 1 . <br />-, MEASUREMENT <br />i) PERMIT ~... 7-:.?l{: _, ~. ~. ... -::{: +::;: -;:; / <br />:, : 17 %~ REQUIREMENT I a y L H ~. f' \ .fir ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EItAMINED AND <br />AM FAMILIM WITH TXE INFORMATION SUBMITTED HEREIN; AND eASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~ / I <br />1~C172TC) ;' <br />ril ITlFOtI OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTEp INFORMATION 19 / , <br />~ <br /> <br /> <br />' <br />' <br />P <br />TRUE. ACCUMTE AND COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFICMIT PENAITIE3 FOR SUBMITTING FALSE INFORMATION <br />INCLUDING `'- <br />~. ! ~ ~ ~ -._ __ <br />` <br />1CC <br />f'F'?. t <br />)ETlt <br />I , <br />TY <br />MENT <br />EE tB U <br />S <br />t00t AND <br />D II ~'~.CI (i j-~7~1 7f ii' iJ <br /> .C.E <br />THE POSSIBN <br />OF FINE AN <br />IMPNSON <br />. S <br />. <br />3] - SIGNATURE OF PRINCfPAL EXECUTNE <br /> <br />TYPED OR PRINTED U.9.C. f 13te. lPUWEir urlMr eww ramua mrr bNAN Mws yo ro i IO,000 <br />trlJamuinun hgT'wrvlwrr PFMwwn emonelrAM6Ywn.1 <br />OFFICER OR AUTHOW2ED ADENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRS/erencs N/ sttscnments oars/ <br />EPA F«m 3320-T 108-951 Previous editions may be used. (REPLACES EPA FORM T-40 WNICN MAY NOT BE USED.1 7 _ PAGE OF <br />/', I' <br />