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PERMITfEE NAME/ADDRESS p YJ. F.etlrryNaWVrmen UDIp...eq <br />NAME C ~ !- ' ii ~ 1 , . :. . <br />ADDRESS NLN ~S 1,?°.1 C.'1^TII~ .• :'^T.•., t' <br /> <br />3NG1.::='-,~~ C; 9'155 <br />FACILITY <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCNMOE EUMINATON SYSTEM /NPDESI <br />DISCNARGE MONITORING REPORT (OMRI <br />l1-15I 117-I91 <br />PERMIT NUMBER DISCNAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 'J i ,` TO `1 r' 'I 1•I <br />!7411/ l7I-731 !1415) l?6171 118-191 !3431/ <br />Form Approved. <br />r . •~ n.... - ~. .. .. ..LOMB No. 2040-0004 <br />^„ _ ~ Approve! exp~ree.05-31-98 <br />(. f"1 Lt1-11 <br />_ DT <br />"t ln•, <br />NOTE: Reed Inetructiorr elore co I Istinp this form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !4 Grd OnIYI QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE <br /> !46531 /5461/ 138-451 !46531 154511 EX QF <br />137-371 <br />ANAyY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /63~a]! !54581 189-701 <br />... 'C' ~iJ. ^:'.` 7f 3~~ SAMPLE rG{:1t. ".; rr•-p .,.-. «ek~ .. ...^.t ~ ~3) <br />^'r ', C ;';!~,•~ D. •, r f MEASUREMENT <br />~..%J= !' 0 ? PERMIT <br />S ;%#',<C•'.-# ^afi Ol {c# #t,:k A o()^• n.~:t~e •t;• ;•:fc :;:~±=s,: ~ F.a- q "'O~ <br />~~:" CC~. ':•~^5 °'r ~c REQUIREMENT #>•tx6 iING$R!f? CFHT <br />:•::':~::Ci ~;~^~~ /n n.v SAMPLE r#3## ;~?###-:~ #.^{L -2r« ;•; t::•:«v;: ( ?T~ <br />H C ~ -', I ~ '. I' ~ T •. MEASUREMENT <br />'_'::c3 r: :, ~ PERMIT r,:##~^-# ;`•;'_##::.^ >: :: t..: 41?Pn AT -k##',k#~ ~'k rs'G#xt,: i F.R- r rMRLY :~"'r;~~ <br />.i t. ~: .'J ' _ ! ~" ; '•.1 ~ REQUIREMENT - #~: # 't N r! I,'1 ° ~ r'?f; T <br />'-drF ,'A", 1'187 SAMPLE ##n.:{rh{: :'k .'y :k :l rc .. :Y .#....: ;, ._ ~ ~>' <br />:i r P'L r ~; ~" , L' ' MEASUREMENT <br />"^_P6C Lr f 1 PERMIT .:: {;{:xt ,T{:#C.'Itc rt!-: 0?S>O4T 'k*.•;;,<...,.~ ...tS:Ad::~ t <br />~ - ^qt <br />y ^vu~° <br />~' 1 <br /> <br />'G'r, CO^!!l.E\_'-; r "r,^~j <br />REQUIREMENTS <br />,. <br />if SrSArn <br />,~crT , J . <br />YI,pCm ST4:' /r1nY SAMPL .,•#:`.•. ,`-##### :...-Y. •.: .:.A:.~.n' ~ '1) <br />' 1'I ^. ::FttAL!'- MEASUREMENT <br />:'C^(.^. i !~ ~ PERMIT G#/k a.#C~' •^.•'•'.=#vr'= i' ."•'='c R~'Pd~T ....._1.,_t::!: Y:±y f,!t:...y _ r T.; l.'~ :n"'rt;7 <br />i .' C O "I ~ Y, k'" S '; -: t. 7 q REQUIREMENT .. ~ ~ #, .`• R 4 W 7.~ T.7 ~ "T <br />i~.l.(i'=I'.t, SAMPLE #P#t;:^. «~«ti.~;~ ..,~1.,. ~If.....w:; ~ ter) <br />-: ^.I!)!!D. ?'I:+iP ^;I37V~I_ MEASUREMENT <br />','! r~ Lb P J '? PERMIT ~~###'X ,? #rf#Rfi,Y .. F. rDORT #L':'#m'' #*: <br />~_. CD9CdRT5 P~L7Y REQUIREMENT ^#~# iL!:'F'~'AMD T'~!!C4 '. <br />. JY .. F SAMPLE ~ {: r:-- F###p:t r.«##.;.~ wrt±:~:;_.« ~ 2') <br />S!'I~DAPF!RT~ C`I^C"'L MEASUREMENT <br />J1~1 )5 S 0 U PERMIT =~~:47{:# =.#C•#{=:Y #:tz REFOR? {'#~«#:: .'-rT'<r•-.~ ( 40UfIr rgrY •r.;•n7- <br />):.. CO!!'IENTS .°"7'~ REQUIREMENT ,::x yR VALi1r T-,XrT <br />• _ . SAMPLE ~ T ,.. ~ {: {Zx~` . .... •`-~:: .. ". r,C ~ ter) <br />:'I'`:: P'IAL::° 'H ;,^. !7C MEASUREMENT ' <br />i~l ~?3 tt ~ (• PERMIT :-t .p ., {=. :-r•#{1 .•` S fi:'. ooo(1RT .:;'hY.. :Yt f+' C ''"11Y^ ~PB [,V 'n... r)q. <br />-6i CDy"'i9T9 -"r"!" REQUIREMENT •• 'aC~GSA•"D '^r'f ("'P ' <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF L AW THAT I NAVE PERSONALLY EXAMINED AND ~ TELEPHONE DATE <br /> AM FA MILIM NATN 1NE INFO RMATON SUBMITTED NEREIN; ANO BASED ON <br />Richard Mtlls S <br />E <br />U <br />R <br />DIIA <br />0 <br /> <br />EnvironmfKltal I:~aaager OBTNN N <br />TNE NFORMATION <br />BELIEV <br />INFORMATON <br />G <br />E THE SUBMITTED <br />19 <br />SGNEFICANT PENALT~S FOR SUBMITTING FALSE IN ORMATIION?NCLUD NG <br />J7O)S7O-2712 <br />lO <br />1S <br />Ce <br />.~~ THE POBSIBILITY OF FIME AND IMPNSONMENT. SEE to U.S.C. 1 1001 AND 33 gIONATURE OF PRINCIPAL E%ECUTNE <br /> U.B.C. 1 1310. IMWW. uMr Mr corona m.r A1cA.d. lnr. ye ro f 10,000 AREA <br />TYPED OR PRINTED ~/>nr+NIIL+11*A+IOTIIIenrWblwrn emmU. rM6 yria/ OFFICER OR AUiNORIZED AOEHi CODE NUMBER YEAR MO DAV <br />GOMMCIN 15 AND EXPLANA I IUN VF ANT YI VLX I IvIND !/rellren0e e// IRBMmInrS neiel <br />_, .. I. F'•4 c';' rd.I:.S• .`:P?~~P °FSJ~°i 7° ;, ''^~(1•.TTy p: glrr - 1. N.,r ro(-.,Ire ^.t n.. ..,r .. _;.. p..~ ~~~ ~Tp7 1~- <br />DT)%ICI'"[N •n9T 1C; cr;r •~ aprr'7°"P AP rinT,lr r T T,• ^rr c n7rr - n.. IT r - <br />;T.4T. S ICC f. - V vT i ~Jn. , ~:. ^v^'~ <br />'1•4•G^ ~'Tn 11 ~.1 ~~C Tlr_ '1TY T•. T .".;1C IFRN T~J^-1 r11• F'^ rLn •Tn Tf- <br />EPAfForm 3320-1 108.55) Prevlous'edltlone mey be used. (REPLACES EPA FORM T~0 WHICN MAY HOT BE USED.1 ^ T ^ , T ^ ^PAGE , OF y <br />