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PERMITfEE NAME/ADDRESS p~BFxdiy Na+/Ler+Nm IJDIC...q <br />NAME h~dd FJAL CJZIP.4KY <br />ADDRESS H A H k '+ I N E <br />P.U. NOX 773451 <br />sr.AKi;DAr SFkIN~i c~ ao4rr <br />FACILIIV <br />LocAnoN;;ALUF.N ;;0 BUi9D <br />ATI!r: GEUn;:E Y. PATTF:RiON+ PINE M+K. <br />NATIONAL POLLUTANT DISCNMGE ELIMINATION SYSTEM INPOESI <br />DISCHARGE MONITORING REPORT IDMRI <br />17-l81 17-l9 <br />~J:,950031 Uu5 A <br />PERMIT NUMBER DISCHNiGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM i i U V TO ) `1 U.~ <br />!16111 l21-131 !14151 !76171 l18-191 !363!1 <br />Form Approved. <br />PJl.D F,/TRIG TO CAaNABJNOA30~-O904A <br />(5110 P. !.M) Approveir(w~~05-31;98 <br />F - FINAL ~ <br />C,INOR VI <br />{'~"': 11C DISCHA4'P, ~--) r:aa <br />NOTE: Reed Instructions before eompletfnQ this form. <br />PARAMETER 13 Grd Onlyl OUANTITV OR LOADING !~ Grd Onhl QUANTITY OR CONCENTRATION NO. FREDUENCr SAMPLE <br /> l46-53/ 15461 138-451 !4653 150-611 EX Y <br />° <br />l31-371 µl <br />StS <br />J. TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s1-ad! 184581 !Bg-701 <br />PN SAMPLE as F.Pa }7::Ra;+ .',c rt ~? aL= ( ? 2~ <br /> MEASUREMENT +/,9 7+9 Q 1~7 IIISt. <br />JU4JD 1 J J PERMIT isOrt 91 SIP aaarpla PyK= 5.'S: #rrvrt -'} 9.O 'ES{LY .i:ait! <br />EFF'LUtt/': .,A05:, VAL'JF REQUIREMENT fiara '1T.NiriU:] P?AXT'7UC SIB <br />3JL1DS. ~TYLSn°LE SAMPLE aaa-a: aFaaaa :;:x~:.:s r;: r; ~., ( ?si <br /> MEASUREMENT O 1/~O Grab <br />DD~4S U 0 PERMIT aaaaaa aaam;fa oYa Oac'XKi:.C ##tl:iL` # .0.$ N~):.[ ;RAC <br />P.FFLUchI' ,;RUBY YAL'UE :REQUIREMENT ;;~•,q:y <br />'JAIL ttX N <br />L/L <br />hf3Nt.H <br />JIL ANU ::dF.ASF. SAMPLE as as Fy aaaaaa ...;: az: :}~}4 Oa <br />( I~, <br /> MEASUREMENT R/A Q l~r] Grab <br />UJ5r,2 1 0 U PERMIT . 4#C7P}' #OCRGO cac C&'J~Re'FS+ #;f(a>;+ >Y jQ f 'ONTIN iitAD <br />LFPLUhNT uR'J53 YAL'Jr' REQUIREMENT nI;J7F DAILY 4"X M!,'/L cENr <br />FLDw, I. :DNDUIT OR SAMPLE ( 03) k:aC;.v aFa ^~;: a:}ac:;:c~ <br />Td3U TltLdIMPNT PLANP MEASUREMENT Q,Q19 D.019 Q 1~~ III6LA <br />SOOSO 1 0 D PERMIT PIIJlFAL REPJAT s~RC04 ##a~. ~ ;_c##>rr . :;-:`;: , :N.;F:/.. ;ri2A5 <br />EFF'LUt;tt'I GAJYS VALUE REQUIREMENT jQDA::AQ,,. D:AIL:Y 7Y tlCD a+•^'~ Pif9rN?H <br />JIL AN'1 .;KEaiF. SAMPLE Gayaaa ( 9LL( k#F~.+; ~%R #'~ r.-r, ;;: ': <br />Y I SU A L MEASUREMENT Q Q 1/'~ Yltsual <br />94Ubb 1 D 0 ~ ~ PERMIT. ~~ #3Lt9SC~ ~~~H.F.POA! ~ ES=1 ~ .~RiD:44 ##$}'k:~.-p~ : ~.:~~$#G:i~~.: ~:k :( :NC~E.l~ SS,FAL <br />EFFLUENT' ;R?55 YALUE 9EnuiREMENT ' INST `PS.ArY. NC=J r:;:c:?_ <br />`M4i1~fi <br /> SAMPLE <br /> MEASUREMENT <br /> ;i~: `PERMIT :. <br />~ .. ... .. .. . ... .. .. .. ..: .. <br /> :REOUIRENIENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~PERMIT~ <br />~ <br /> ~REQUIRENIENT~ ~~ - ~ <br />~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 cERTIFV urlDw PENALTY of <br />AM FAMILIMt WITH THE INFO uw TNAT I HAVE PERSONALLr E)(AMINEO AND <br />RMATION SUBMITTED HEREIN; AND BASED ON <br />r'-l TELEPHONE DATE <br /> MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~ <br />te <br />. <br /> <br />Richerd A. MWIPlOII <br />OBTNNING iNF INFORMATON, I BELIEVE THE SUBMITTED INFORMATON IS ~ <br /> TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT TNERE µE <br />INCLUDING <br />SIGNIFICANT PENALTIES FOR SUBMITTING FILLSE INFORMATION <br />-"' ' ~ / <br />P <br />Q <br />' <br />! <br />t <br />Qt <br />E <br />ViD9 Pte6ldeIIt , <br />1' / 72 <br />3.. <br />{721 ~ i Q <br />/ <br /> THE POSSIBILITY OF NNE MID IMP11150NMENT, SEE to U.S.C. 1 1001 AND 77 / <br />610NATURE OF PRINCIPAL EItECUTNE <br /> U.S.C. F [Ste. IPNW14+uMw N+r mnm+m+v ircA.d+l+e+re ro 510,000 AREA <br />TYPED OR PRINTED rNS-mvnrunbWniA'PnA'nWbnP+AnemmN,+MSy++rA! ) OFFICER OR AUYHORIZED AOENi CODE NDMl1ER YEAR MO DAV <br />_ COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rsfsrencs ell sttechmsnts here! -- <br />SETTLLAyLc SJLIDS LI7II iIAIYED POR LD-YR, 24-HA PRECIP sveAr :.ULJF:~7 i0 dURpEN flP PRO©F R?;U79eM£tiFa' IN <br />-_-PAdT I.'i.1.D, P. 5. STOHdaA7ER l±ANA;EIEHT ?LAN DUP 1-I-79. <br />t- F Preyo'ue editions me -be-li "sad.--- --- - -- -IREPL-ACES-EPAfORM 7~0-WHIGX-MAKNOT-BE.US€D:1 _ PAGE __ _1 <br />x. i <br />