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PERMITTEE NAME/ADDRESS perbd. FsWryNsdLocaum lJDlQGrmp ~ Form Approved. <br />NATIONAL POLLUTMT DISCNMOE ELIMINATION SYSTEM /NPOESI <br />. <br />NAME , <br />' <br />~ <br />r ~ <br />ON <br />t ~ <br />, :. <br />, . _ ~ <br />_ <br />~ w I. ~ , <br />t DISCHARGE M <br />ITORING REPORT lOMRI q ,. , ~ O B No,.204Q-0004 <br />I . , .. / 4 F - <br />: ~ { . <br />° <br />' <br />. <br />: <br />1-161 7 7-191 <br />ADDRESS ~ •~• h ^ ~ •~ (1 C (~ ~,; Q 7' 1 ~ ~ t ~ (?~ Il . \ . } APprovelLerpirca OS-3 <br />~ F, <br />N d Y: t :• ~ J H .L n j 9 PERMIT NUMBER 019CNMGE NUMBER c_ p? ~ ~ L <br />FACILITY MONITORING PERIOD <br />Y YEAR MO DAY YEAR MO DAY <br />LOCATION <br />~ <br />i Y ; I: <br />, r r T ; _ r J D I -_ <br />. <br />. <br />. <br />t_ ii!•J9 FROM ..•• ~ll TO .. .~.. ..A GE ."~ <br />' F c:: '• ...: E L 9 % it A C t n /7077/ lZ2-131 174751 176171 118.191 !30311 NOTE: Reed Inetructiane before eompletinp this lorm. <br />PARAMETER !3 0.rd On/yl QUANTITY OR LOA C !~ Grd ONyI QUA NTITY OR CONCE NTRATION NO, FRFOUENCY SAMPLE <br />l37-371 !46531 /Sbe1l l38-451 /4653 l5L6/1 EX OE TYPE <br /> <br />AVERAGE MAXIMUM <br />NITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM UNITS <br />/ss-ssl MALYSIS <br />154591 <br />169-701 <br />~ .. a'. .. :lt i:A :.° <br />v i , , a ., SAMPLE <br />MEASUREMENT .. ^ <br />J <br />/ <br />'' ~I 4~ .;~45>t <br /> <br />~ i. is rl <br /> <br />~. ~ G ~ 7 <br /> <br />Vl~ <br /> / <br />l <br />~4~.., L o r, PERMIT >::'v>:'{:^;.:' ,.'-:i•OkT L:-v ^'>:•.aOt: y,,':-'r;:'.. ,. 'x`k:?LY iISUAi <br />Lr ~ i. J .. .., - .: n 7 S 5 U +.:. 7 REQUIREMENT .'::•'l " d :t L /' _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />~ <br />~~~~ <br />- <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERRLE PRINCMAL EXECUTNE OFFICER 1 CERTIFY UNDER PENN.TY OF <br />AM FAMIUM WITH THE INFOR UW THAT I HAVE PERBO <br />MATION SUBMITTED H NALLY E%AMINED MD <br />EREIN <br />MD BASED ON ~ TELEPHONE DATE <br /> ; <br />MY INDUIRY OF THOSE INDINDUN.S IMM WIATELY RESPONSIBLE FOR \ <br />1 <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COMRETE. I AM AWME THAT THERE ME <br />SIGNIFCMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />- <br /> , <br />THE POSSIBILITY OF RNE MD IMPI1150NMENT. SEE 1B U.S.C. f 1001 MD ]] <br />SIGNATURE OF INC <br />EXECUT Z <br /> <br />~ Aq.~ a w ro F10,000 <br />wo'~3~. <br />a ~ rt <br />en <br />n IPAL <br />NE <br />A EA <br />TYPED OR PRINTED w <br />. <br />, <br />a OFFICER OR UTHOpIZED AGENT <br />CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e!/ sttachmenm here) / <br />.,-. ~ i ... 1.?''i11'(. :1.~ .,. k31'J :'.:~ !. ._: i~L l.i '~ _~~:':.. 1.: .. - i1 .:'f' `r .,•y 6A ., 4'i' -. '1. ii: rr7 r. :'gi'n. :•i <br />•r r <br />ln~. ~ ~:,i TL;: A'r L,. _::17_'. -.I.'•l I:: .ni7i~~ L~')-( ~:~;Y r24',. , .'ll L'.+ .1T~• ,.. Plh.' ., ^ilf' ?PCLiF S' l.r..-. <br />17 i_ r_.-LCV_C: ~ T I: 1 ... Vn••T~ •. ~ T : 1 0 <br />mey be used. (REPLACES EPA FORM TAO WHICX MAY NOT BE USED.1 r ~ r ~~~ . / _; ~ 11. t L,1 °. 1 <br />