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PERMITTEE NAME/ADDRESS (IMi6 Frd~ryNsW/ccaNm r/Drpnar) <br />NAME ^~:. ~ .. ._.~~. LL. Y ":,AL :~i,9~ <br />ADDRESS .Ij ~~ ~r ~'~~ i": .''r :. E': !C YA•i i't <br />FACILITY <br />LOCATION <br />'.T!'\: ~J?.;~I~ ;. '~ ;1.F;Y, *I'r%n? 4CYY <br />NATIONAL POLLUTANT DISLNMOE ELIMINATON SYSTEM (NPOf$l <br />DISCHARGE MONITORING REPORT lOMRI <br />l1-161 Ill-191 <br />cJO~zit~a nit Y <br />PERMIT NUMBER ~ DISCHAAGE NuIABEfl <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM I/ ~ TO '1' ,"1 <br />110-111 117-731 !7415/ (1617/ 118-T9/ 13031) <br />Form Approved. <br />r rr v- l. r r T ~ r O,MB Noo 2040-0004 <br />f` rr r 1~ ~ ~ - Approve! exP,iros 05-31-98 <br />_ ..:p• <br />„ , .., <br />NOTE: Raed Inetructlorq belora completing this form. <br />PARAMETER !J Grd Onlvl QUANTITY OR LOADING !~ Grd Onhl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br /> 116531 154-611 l3B-151 !4653/ !54611 QF <br />I31-371 EX <br />ANUVSIs 7YPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 1s7-s]1 (51-681 (5.?70I <br />... .°GC'!' -iTAT2" 7D.4Y SAMPLE ~~R': ~.~ r-r.,32r,-: ~ ~~~ ti: ry:~.; A.:_ ~: r,~..A-. ~ ~;~ ~/ <br />(A ~ p H [o~11 <br />C,°,hI.)i~A94,.7E- MEASUREMENT / 1z ~ <br />..1 Lj r n iJ PERMIT ^,.'r:h 1f -.tR 44 <br />~ll.h~~ L)) ].}~=~Y.~SKA w.AAily <br />' 4' ~ / T7I <br />,~ y Tf .T•"_~ <br />•.l <br />~i.L CO!:"2!i ^.• ~ flF,Li: iJ REQUIREMENT t!"r? E!y YALLsc r_ryr <br />?C1 STA1'RF. 7P.'lY SAMPLE ~F: ###h'./•;v „- rki tv~+,-;: sl <br />23) <br />c <br />a~+l <br />= `I ~ P I I" 6' P H A L F, S MEASUREMENT <br />- - <br />- a~ <br />- <br />- ~ Z- n <br />C ''.TC :, 0 0 PERMIT #"k*#;c r. rR~#b.ti ~ Y#7 OJ OtI CTYi# yr {:~~~r I Ep- ( .t'RL!' .?C nF. ;1 <br />.= CO!1M~81'S c~£LOp REQUIREMENT ##XX aV YALn'' CFVT <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 /> 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 lJ1W THAT I NAVE PERSONALLY E%AMINED AND <br />AM FAMILIAfl WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> <br />3ichard R9111s MY INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />~ <br /> <br />CnVIrOnlRen tai manager , <br />TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ ~ <br />~~ / ~ (970) 8 i 0-? 712 ~ ~ ~ 5 ~ J <br /> , <br />THE POSSIBILITY OF FINE ANO IMPNSONMFNT, SEE 19 U.S.c. 1 1001 AND ]] SIGNATURE OF PRINdPAI EXECUTNE <br /> U.S.C. E 1]10. fFYrIf/EY. IMw Vrsf Aeffuna nvV NcpdA FAMAW ro F /0,000 AREA <br />TYPED OR PRINTED Ansrmuhwnr Mprlsvrfwfr Pl bnrfrwlsmmdrArWSr~al OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMON I5 ANU CNLArvq I IVrv Vr Prv T V I VLA I IUrv, 1rrele/IDCI e// BIreCOT0D6 ne/6/ <br />rL] L.`.le li FJ4 cT ;:fQ.'-~~~~1k''.. 7Ci or ail (.p^ .~C L t <br />.. _T.~ 11 TTY ~vr ~ <br />^T~/ ~°T <br />f ve. r•v.. ~~Tl <br />L'^C_-'T 11 <br />.1 <br />~l s'.n <br />T')lr <br />111 ~ <br /> <br />p-.~I>tATIJNS t-. <br />vm')XLCT*Y'E. RPT <br />L:)••'.ST S°':L .4T Yfi?C`~ / <br />^P4Trr-Tr-1LLY <br />rTrf~TF• :crap r,. ,:FLT ~ <br />. <br />T^r~m r C7Vr~n~ <br />I. <br />_s- ~l4C POV CD 1"r~;r TCrT ^anv Efo f1 D•)m Twl'- na rnr- T~~cm n- lfnn _f nne. <br />, <br />c w <br />EPA Form 3320.7 108-951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) i <br />~ <br />~ <br />„ <br />~ ~ ~ PAGE O <br />- <br /> / ~ ^ <br />_, <br />Z <br />, r <br />n r ~ <br /> <br />