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PERMITTEE NAME/ADDRESS prrV4 FsWryNw/Locrnm dDlBr.rwr)
<br />NAME C y l' N n^ y s ? A .! '! '/ ^ r 1 T ^ l
<br />ADDRESS ' T ~ '~ ~ r ~' - ~ -
<br />r . - I~ r1
<br />FACarrv
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCNMGE ELIMINATION SYSTEM INVDE$l
<br />DISCHARGE MONITORING REPORT (DMRI
<br />11-161 117-191
<br />~~_0'727754 f"'? .
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM 'f TO .%a i~'
<br />110111 111.131 (14151 116271 118-19/ !36311
<br />Form ADProved.
<br />• ~• ~ :'!15 ~~ ~~ --OM&No~2040-0004.. .
<br />~ Approvd e~pi(es 05-31-98
<br />?C J
<br />,~ NOTE: Rasd Inetrucdoru baf • co latinp this lorm.
<br />PARAMETER l3 Grd Onryl QUANTITY OR LOADING /4 Grd OnIYI QUANTITY OR CONCENTRATION NG NIEOUENCV SAMPLE
<br /> (<6531 !5461/ 138-151 !4653/ 154511
<br />EX DF
<br />TYPE
<br />131-371 MALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is1-sal !64681 168-701
<br />_~i ~.UUCTIVLLY SAMPLE .kO:kG:x .,~23#: C;L;+#.~:: ( 17-)
<br /> MEASUREMENT
<br />D 1711y E1 1 PERMIT .:.xRR ;Y {:#?## r g#~r kn;;.;Ct• N~P747T Tr^T(?•; iT. t ^i0/ =. '~T'4i~Y =n'i'
<br />FFi.UF.6T •..~ 7 1.4 LT1~ REQUIREMENT aAkG !)9TR AY!' ^, `T'^Fi "..X ^
<br />'•:i SAMPLE Y;`•4#?# RSttt#? '~tf•`-.#".' ( 11.)
<br /> MEASUREMENT
<br />)Ull it f) 1 (' ^, :..PERMIT ..##O?AR. ~ A10#3 iFd Q R#k ,5, ###### $~O
<br />E6PLY ~
<br />:RA1
<br />i F:'LUEhT GP"I~~ Y.4LU REQUIREMENT ~ ~ ~ 4r-:0 >NI NI14 tT!! IM17[jaLJM SU
<br />-O:,?DSr ;i P.T°~~..-9LF_ SAMPLE {~; .qtr :" ~'-SCaa to tC#Y=xr ( z~~
<br /> MEASUREMENT
<br />JDti~. ~ ? !) J PERMIT :i`(r."•~: ..t:trt:.^; :~ ~:::: rkrsy'R~k# T,c ~(1..,.. 7rTC1~m ( :d"_P.f :RA I1
<br />i.: .' C(;:'r "RTi T°. 9ELDM REQUIREMENT ~ 'i t)t54 A9!; DA i IY '"$ `1L L K7N311
<br />iU:. i:r5r SS^TLFARLE SAMPLE -•. ..-. +f kGt Y*."-+: r-t: ( "'Gi
<br /> MEASUREMENT
<br />iU~'=S 1 U () " PERMIT .,.. ,'-:h t< ',:vtF;-r" .•+`~x .Y t: +k #:`!; '1 r. D7°" ~.~ r y~r/ :AA'3
<br />-~');, IS .;'. •• GPDSS YXL7F REQUIREMENT 'x+k `--? 3D^~ A9 i fiATL~ '77 ~f,/(, r7VTc!
<br />!1.. '. `1 '! :HEASP. SAMPLE ,. ~3r.~ *: ..k ;a#•, ##':'~~~: nYa::k;-'~ ( Ia)
<br />~~~1!r :C°H-.BRAY "RTN MEASUREMENT
<br />~,DSUo i 0 ^ PERMIT ;: t:C#~~,= .;::::11#t: Y~ O ~#7 };x##rr ##P, #~X'.- t.Q D"T I'1 "?AS
<br />n~'LOEt+° i,?J;S 4'A.L'J° REQUIREMENT OaCR INiT "?1!R AC%/!, t;rvT
<br />!.Uwr N C7'~7'I': _' 7? SAMPLE ( 73) ':'#C:k:`• .'l'r~:`::!::-. vCY: "-.•:
<br />"li',I Trl 4T M~lr II*'IIT MEASUREMENT
<br />=DD'i0 1 ') ~ PERMIT "tFP~gT )PTI7MilL s####'* ..';,~YTyy-.~ r,:trntr:;: ' #r,:= 4 F''Y`?,y N^T~'t
<br />.?iLU F,HT Cft~;" V3 i.'1~ ~REQUIREMENT j;/UA AVC DaILI '1Y M!"7 'x^#'*
<br />. V :,d A• SAMPLE ^R:: ^; :: ,: ( d~)) :. ix;AA:• .v ~Y:., :.fit. _:~;
<br />I S U A L MEASUREMENT
<br />~-I Jo `~ 1 '7 PERMIT t:Y: r<YZtr ) Y F5=1 r~#'%"v ..-.. ::a #.:x {:off r #-", ~ f:'?uf.Y 'I3(J4T.
<br />.F:'LUF.NT G~'~.-~ '; ~~.."1F REQUIREMENT Iti jT .y p,Y V/7=D . .
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF l
<br />MI FAMIUM WITH THE INFO AW THAT I HAVE PERSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE
<br />
<br />Kichard Mllls MY INOUIRV OF THOSE INDIVIDUN.S IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNIND THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />
<br />~aneger
<br />Environme
<br />ts I t TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME
<br />TIFS FOq SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />SIGMIFICMT PENN (9]0)970-2]12 1O IS 98
<br />.
<br />n ,
<br />.
<br /> THE POSSIBILITY OF FNE MD IMPRISONMENT. 9EE 18 U.S.C. 1 1001 MD 33 g10NATURE OF AIINdPAL EXECUTIVE
<br /> U.B.C. 1 t 310. IP.+Meb Wr rMs mama mrY MreMrrr rrrrr ra ro r 10,000 ANEA
<br />
<br />TYPED OR PRINTED
<br />rW rv muirwn pw'fa++wrte/Mnrwnemmeu.M6 WA'Al
<br />OFFICER OR AUTHORRED AGENT
<br />CODE NUMBER YEAR MO
<br />DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/ersnce s// sttschmsnfs here/
<br />=-..TLEA?LE ;~(.r';,. LTr,r?n 1~ .IA_TVF7 (i.7C 'F'1 J}'±Y Ir >10-VDr 711-vF' aaL.r'•- ..~.-.... T. r.M1T...'~. i:': T,+I,?
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<br />-u1y9•irlr T.'s-°' ^r Tn w:_r~~n+unnc r~/
<br />EPA Form 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE U8ED.) ^ n T; n / O o ^ 11 ? ~ _ ~ n 1 Q PAGE t OF
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