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PERMITTEE NAME/ADDRESS IGrLbfsWryNwJLzura. rJprDrwd NATIONAL POLLUTMT DISCHMOE ELIMINATION SYBTFM //IVPDE$l <br />NAME DISCHARGE MONRORING REPORT (OMRI <br />, n~i: o M ~ „ , ~ <br />J dL <br />ADDRESS R°J =;LF MIK.°. V. i --nnnnr nc <br />w ~ w ~. Y - n ~~ s • ~ ~ uu <br />y~13 <br />5. <br />Uls~~r, y <br />Yi 11"Iv PERMIT NUMBER DISCHMOE NUMBER <br />r <br />FACILITY .-..TrT <br />v•CT ti <br />O ~"~~~ <br />r 1 <br />Me <br />•I Or' `~ ~~~ p <br />Sn13'7 MONITORING P R 0 <br /> , <br />p <br />~ T N r YEAR MO DAY 'YEAR ~MO DAV <br />LOCATION <br />ura•r.l~ Y <br />m ~o~ <br />e ~U '71J9i FROM 9'1 07 01 TD 9q 0a 20 <br />A T P M r vT Mi r . <br />~- <br />~ ~• .• . ~ rly n r- v N v n i r r r- n /7b711 Ina31 rv~-~sr v~~n v9aor rxl.en <br />Fo~,rAmg Approvqepd~. ~ <br />ACr1TP 94T TRSTI pGpPP~le~xplrn yes o531~88 <br />(sl?r..s se) ~ 123u5 <br />F - FI~IIL r <br />!+IanR <br />NOTE: Reed Irnwetlone be or Istlnp this form. <br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION Np, FREGUENCY SAMPLE <br /> !46531 l5b611 I38-151 !0653 /51-61 OF <br />I3I-371 EX Mursls TYPE <br /> AVERAGE MAXIMUM .UNITS -MINIMUM AVERAGE MAXIMUM UNITS leI~6J1 <br /> _ I5a-5gl (63701 <br />L~~J `iTAT~t6 48N4 p'I '}aRFRn. 64p0aR .";:rYt}.~ 4#rr::t;: ~ 27j <br />"c:kIOJA~'RI11 MEASUREMENT <br /> <br />TANfi 1 0 ~ ...PERMIT .... <br />~ ~.~... .. <br />~ <br />~ .,. <br />aCaa;?IaC ~, <br />...aAi4€9ij1d ~~ <br />~ <br />sca <br />~. ~,~ <br />10Q~:~ ... <br />~ Z(~r#1#IC~. .. <br />~.:~.>rLc:C+:s91.~ <br />>P4- <br /> <br />TBL <br />T• <br />!!AP <br />= 'F' Il°NT - <br />F <br />I REQUIREMENT <br />. . . ~~~~ ~ ~ <br />~• . <br />+ <br />~ , <br />I ^ .: nE <br />. :.:. <br />~ ~ r¢ T <br />L"SC .'i'P~1^!tG 9G!IR .\~[ SAMPLE R:GCR: 4xniRar _ <br />F•14^ <br />'' 'h'.. _ _ <br />~ ~3) .. <br />FBI V~[~11 '~ <br />~ MEASUREMENT <br />LI <br />J <br />1' A 4 h C 1 Q [1 :t..'. PERMIT.. <br />: <br />E <br />U <br />R <br />M <br />N <br />AaDR:C . <br />...aa~:as~t+... <br />a,-~ <br />.'~4U. <br />~ ~oaaa~a~~ <br />~~~ aa~o+x>r'~~~~ <br />Fp~- <br />~~~RT <br />~Y~~~ <br />c4IlW <br /> 'R <br />Q <br />I <br />T <br />E <br />E . <br /> :. <br />r'G'4T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~. ~:. ~ .~~ ;~~ ~ ...;~. .; :-. ~ ~ ~ ~. <br /> :REQUIREMENT. ~~ ~ ~~~ ~~ ~ ~~ ~ ~ ~ ~ ~~ <br /> SAMPLE -- <br /> MEASUREMENT <br /> PERMIT. ~: <br />REQUIREMENT. :~ ~ ~ • ~~~ <br />~ ~~ <br />~ ~ ~ <br />~~ <br /> <br />r <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~~~:~PERMIT~ ~ ~~ ~ ~ ~ ~~ ~~ <br />~ <br /> ~REnUIREMENT~. . ~ ~ ~ ... ~ ~ ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~ PERMIT ~ <br />. <br />~ ~ <br />. <br />~ ~~ ~~~ <br />.. <br /> :REQUIREMENT~~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> ~~PERMIT <br /> .REQUIREMENT. ~:: <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENKTY OF <br />AM FAMILIM WITH THE INFO UW THAT 1 HAVE PERSONALLY EkAMINED MD <br />RMATION S <br />BM <br />TT TELEPHONE DATE <br /> U <br />I <br />ED HEREIN; MD BASED ON <br /> <br />S <br />C MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />U <br />_ r1 <br />p OAC Y <br />11 , <br />TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT TNERE ME <br /> SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING it <br />y ~ A e. L , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 1B U.S.C. 1 1001 MD 33 ~ 1 ~ <br /> U.B.C. 1 1318. IPxWFi. MMtl dM. FYBma PNY YNkd. rws w ro F IO,OOp IONATUR OF PRINCIPAL EI(ECIfT <br />TYPED OR PRINTED uW nnMr.nun lnp+iauwnt olMMwn 6 imndu uM6 yra/ OFFICER OR AUTHORIZED AGENT OD NUMBER YEAR MO DA <br />rnuueurc •un cvui •u•r~nu nc ..~.. ..~..~ .:.....c .o_.______ .___._ C <br />E <br />;f.r. I.A.l~ DP S-7F F'JP ~RrRILS 7P 7°ST PRpC?DU4N„ HEc(oft'r LC 50 - ^T~TISTTCE.L ^^.?vr :'~-{v.eTC '.u{('~-! {~ <br />LETHAL T.J SU' r7F TP.SP 'llt6Rt~ISK51 AND llrrAC:[ A::!ITE TORICI'TT TFS'r 4>;P•']a'r c;)ov 7/) r~~w. ;•nl;.••~ n•' 4f.1. <br />EPA Form b- '1 -95("'Piavious ediuone 4neb b'e sed. ' IREPLACE6 EPA FORM Td0 WHICH MAY NOT BE USED.1 PAGE OF <br />