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PERMITTEE NAME/ADDRESS pvY4 FrY,ryNaw/Locanr l/OrQinnq <br />NAME ~'(')::~~ .; , T. ~ -. ' <br />r ~_ '• <br />FACILITY <br />LOCATION <br />~r:a: tio~la; :. .:r •I, ~ ~~nL ,I..YY <br />NATIONAL POLLUTMT DISCNMOE ELIMINATION SYSTEM INPOE$l <br />DISCHARGE MONITORING REPORT (OMR) <br />l7-161 17-191 <br />~D(`~7/1i4 ^~p <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 'i ~ .:~ TO '%~• 7 Z^ <br />!76211 /77-131 !14151 176171 l7B-791 !34311 <br />Form Approved. <br />v ~ - t -~ q F n TnOI~B\NO: YDAO"DDQ4F V <br />r Approval a giros 05-31-98 <br />( - - ; i <br />A NOTE:, Read Inetruetioro bafor eo letinp this form. <br />PARAMETER l3 Grd On/YI QUANTTY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br /> !06531 !54611 l38J51 /46531 /5461 OF <br />l31-37) EX <br />MµVSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs7-sal !64681 169-]Ol <br />I3'-,N, T';?RL SAMPLE ^FR rzC R#.".: :=-;:': ; ##"+r•~ ( 7 ~1 <br />(A rl F~1 MEASUREMENT <br />;1 ~:a5 7 () ~ PERMIT #RR aR;. ~ ~: R~IEe40 AI ,: xx ris rkr-•.~*t Dp nn q'~ DarnuT t .$""~ <br />/ 'non <br />„-'. •'0 ••.cy '~41'S !fFL~d REQUIREMENT R#~R 3.'1n L..~Or nRIi.v ~r rr/1. , <br />05T~N <br />?~e'C~+, TOT4L SAMPLE F43RR4 x443?~ Rprr:;t# <br />{ 1~) <br />I <br />(AS F;1 MEASUREMENT - <br />:1~J4S 1 0 ) PERMIT 4~kRR4R :X t:sR;--# :7 :#~E'J %`•R 3,5 7.(• NCE/ .pA~ <br />•~r'L;IE*+T ~R?';S PAL'; REQUIREMENT -`r4R ~!}f1F. AI^. D4iIY M[ M. /L MON'Py <br />.,'i, ! N OND7I1 L R SAMPLE ( ;7 J) ,.':5,4$ . X:=;4=`:. 7~.',-:; ;-t: <br />,, "'J Tr'.:;ATd?N* p1 r •" MEASUREMENT <br />:.. \/'i0 1 Q 0 PERMIT I?'r'O0'.?T Je TIOVAL 3Ct 2:'~-^.:# #~.!:Yy !•, ;y „. Rr„;: «; t Ta••VY _V`~T4` <br />. <br />.. ,41 L+tl'f .^e~RO~i :~ '!4?.. !- REQUIREMENT 3i, lt'1 ;~Yf,, 047LY f1Y '1 ~J~' <br />i~.. 4D aEtE4" SAMPLE -••.. ( i41 (t ae'S ~. fe ~t ...::-1 $B' `#t: f:'. <br />l I i 7 A L MEASUREMENT <br />_-ti (~~e~ 1 ~ r.) PERMIT t i:.!; Lt .k ff l I( v-=1 ~'~'tCLw•: g: l•:: ?::;t ye i. Yr+; ;,~.Y a::~ P~~'L:' IT_}I.AT_ <br />'{: L:7 L::•T GR'J ~\~ L'4LIi~ REQUIREMENT I`SiT aAY 9r''^ <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 EXECUTIVE OFFICER I CERTIFY UNDE11 PENN.TV OF UW THAT I NAVE PERSONALLY E%AMINED AND TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br /> MY INQUIRY OF THOSE INDIVIDUN.S IMMEDIATELY RESPONSIBLE FOR <br /> OBTNNING THE INF011MATION, 1 BELIEVE THE SVBMITTED INFORMATION IS <br />Richard tJlill~ TflUE. ACCUMTE MD COMRETE. 1 AM AWARE THAT THERE ME <br />SONIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />~~.TVironmentB l "•IHnacter , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 16 U.S.C. f 1001 MD 3] <br />' SIGNATURE OF PIIINCIPAL E%ECUTNE (970 ) 870-271? ~ ~) 1 -rl 48 <br /> U.S.C. E 1]10. lPrWh. MMY e <br />wr mevna rNY IntAIdl /uwa w ro FID,000 AREA <br />TYPED OR PRINTED .rrC ev muimvn hrAdrdv.lrlr el Mrrrn6mone1. rM6yrn.l OFFICER OR AUTHORIZED AOEM CODE NUMBER YEAR MO DAV <br />GOMMCn 15 ANU CArLAnIA 11Vn Vr An r YI VLA a lUrv, IrterelOGCe en eRlGOTBOTS nB/9/ <br />~LI':.ENA C:: LT'f C:"i F''~' °•_)7F ?7']!: ~ ;T'TTf.?4 sLL: SlLTCS (L7' ')F1 ~^n1,v r; LY f^ re "^-y:+~ "`C-'{.~ DD\~^r_n sv,z arm <br />I. ~1.AI"F.D. 1p': T.A.7, 2: 1°• S^,3 97R'1°?. J° !`3!)~F ,.'7;t T•i^vr:a^. '1Tr .vrOC^_,--. rn.\. vF1T< <br />F/F 'f- ', <br />-atv cee.or rr- c uc On~rr.,^ TV'-TiJ it^PT'r •I ^._C \nTV .1T0 .,/ <br />Epp Form 3320.1 106-951 Prevloue ediuona may bs used. (REPLACES EPA FORM T-0O WHICH MAY NOT BE USED.) ~ m ~ ~ /,~ , ^ /t ~ ~ -1 ~ ~ ,~ PAGE ~ OF <br />