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<br />PERMITTEE NAME/ADDRESS /Include <br />Farilin~ Na~nq/Loemion if, Qi(lerrnfl_ ~ / <br />NAME _ fir'{' ~'1~3'1t1"~1 I . C ~ Q 1 CAI . ( C <br />ADDRESS/n c--._,.-_-_-____-----5- <br />--__------_~~ ~'f WO/~ pr-~c <br />FACILITY ~- <br />LOCATION ~ ~' 1~~-r(~ I-'~ h A h wLY - <br />jr.. ----- - ~----~- ----- <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES ) <br />DISCHARGE MONITORING REPORT r DINRJ <br />l?-lfi 1 (17-191 <br />PERMIT NUMBER c mur+aER <br />MONITORING PERIOD <br />Y R' D Y Y O DAY <br />FROM TO <br />/:d-r1/ n_z-?fir I]a?s) lie-?n /1.e-'9r rld-rl, <br />r;l, .-~ .:~.1 <br />_ - PT ,I~? <br />7' <br />. .. .I ti <br />NOTE: Read instructions before completing this form. <br />1 (- <br />Form Approved. ` - ~~: <br />OMB No. 2040-0004 <br />Approval exp~ire~s 10-31-94 <br />- V V ~ <br /> ~ (.i CrrJ Onl)'J OUA NTITY OR LO ING (J Card Onl)'J QUALITY OR CONCENTRATION <br />PARAMETER (Jfi-i it (sa-A/) - iJ f`J nU <br />(JS-05J rJb -J NQ FREp <br />UHrvCY SAMPLE <br />' . EX O <br />5 TYPE <br />(?_ <br />-771 ANgD51 <br /> ~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA %IMUM VNITS 6?di VaC <br /> l <br />g ~M6yl rn <br />r <br />::. ~)'I ~I ~~•r15~ iCt ". ?:'•' / nJ' ~J$ri~<'-S ': F:~'.Xhf~... . <br />. <br /> SAMPLE . <br />• ~ ~; ~i 1l• MEASUREMENT <br />'l .`, ~: '.~• 1 Sri Prp~l: T >f c =1 d64R ~ gsylk##S"+ rt#$rih$ arut ~r rr; ... r <br /> PEP.MIT <br />.. I!: •J` -a'la ~ '~f, '~" REQUIREMENT Tyc-T MAx 11.1=0 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMEIT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE l <br /> MEASUREMENT / <br />r <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 EXECUTIVE OFFICER I cERnFr UNDER PENALTY OF LAw THAT I HAVE PERBONALLY E%gMwEp TELEPHONE D A T E <br /> <br /> <br />rLl_ ~, Q r ~ ..I AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEFEIN AND BASEp <br />ON MY INQUIRY OF THOSE INDI VIpUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION IS <br />,J <br />1 TRUE. ACNRATE ANp COMPLETE I AM gWfRE THAT THERE 4FE <br />SIGNIRCnNT PENALTIES FOF SUBMITTING FALSE IrvFQ4MATIgV INCLUDING <br /> <br />! <br />M h e <br />THE POSBIBI <br />OF Fw <br />PR <br />NM <br />EE IB <br />001 <br />A <br />T <br />S <br />f ~ Z ~1G7-7717 q 9 ~ p ~ g <br />Y <br />~ I <br />U <br />Y <br />E ANp IM <br />O <br />ENT s <br />use <br />i <br />Np <br />33 <br />SC 4 <br />9 <br />P <br />h <br />l <br />d <br />Ri 516NATURE F PRINCIPAL EXECU IVE <br /> <br />YPED OR PRINTED u <br />U <br />131 <br />( <br />rna <br />rs under r <br />esr aawln mds nr <br />u <br />e /rocs ~ <br />SIOprHr enJ nr n~a umum improonmrnr or herx crn b rnpnih• and 5 ~mn l <br />OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CO E <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS !Rr(erenie all allachmenls hrrel <br />..1"I^ V7i.).TI-.° 74,.A.rI~ .~n:•Tyc AN`+[IALT.q P. ..~:.;~ )Z/7.9 `• C4/Z a: 4°°IIL.T~ ct' 61l T.dTr~ '.'I~H q-r/-~ toTT/ , <br />')"F-Z.i.Y, P? 1'?-:l• GkAb SAMPLE A~/e.LY~IS v;7^. .1?L ~3FA.~i: Rr~UIREP I° YI`TO'.; 54FFN [i nP°P^lcn _ <br />~-:r~ ~ .~ T ~ aF•r; r ~.-M^ n-RA~~~4~r b5 S1V°1~T~rn ~-iy T c APD Y. <br />EPA Form 3320-1 (REV. 9-BB) PleVlOUS EdIIIOIIS /11dY be USEd. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 PAGE OF <br />00037/950623-17u3 2 <br />