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PERMI7TEE NAME/ADDRESS (1riiL. FrWryNw/Iscm+m UD+pmnq <br />NAME >{tRH ~Jct ~Jg r,; .., <br />ADDRESS fl A H R A L i` <br />P.Ci. 6J~ 773'! 17 <br />STf:A~187.1r J~~T~';:: ~1 Jp4/1 <br />FACILITY <br />LocgnoN:ALDcN .:'] i0'l3J <br />a rrv: ~::,,~;a~ y. : ~ rr•:a I J..r +tss n;i. <br />---r----~,- ._--. _- _ <br />NATIONAL vol.iurANi DiscNMGE EuMINAnoN sYSrEM lNPOES7- <br />DISCHARGE MONITORING REPORT IDMRr <br />l1-161 I7-191 <br />~J;R50031 G u <br />PERMIT NUMBER ascHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM J1 U l:l TO U1 JJ ~ <br />86171 l11-131 /14151 (1(x17) ITB-191 f303f1 <br />FO1m ApprOVea. : ;•. <br />PDpD D/TRIO 70 CA4~BJEioA7704Q-0Qq,,4R ~`:. <br />(S U B R +f' N) APProvei G ~Ir~e OS 31-98~, <br />F - FInAL <br />'ItIOF; <br />NOTE: Rud Inetruetlane belon oomplatinp this form. <br />;~ <br />-.rt <br />is <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !1 Grd Onlyl QUANTITY OR CONCENTRATION ND FgEDUENCY SAMPLE <br /> /46531 !5451/ !JB-451 /4B-5 /546/ EX DF TYPE <br />131-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(61.6!1 MALYAs <br />/5q-561 <br />169-701 <br />1d SAMPLE .-..~3~ .-r:'..x ~, :k'= ( l2) <br /> MEASUREMENT <br />,li/iJJ L 0 0 PERMIT '•##tt;+: #,~91t."t4 ##:: i..i >,'s'xt'.t # 9,0 $FRI.Y `NSLTJ <br />i'iLU• `,r ..RJSS 'JALJE .REQUIREMEN7~~ ~ <br />~ ~ - xi.-~p ~ YI:yjpy~ ~ - KAYiKUI$'.. SO <br />;Jt.IDJ, .,.TrLr:a'L.°. SAMPLE r~'k <br />RRO C+kPX?r 03taik{Fr ~;:# #~ ( 25) <br /> MEASUREMENT <br />.i'JSJi i 0 J PERMIT 'r~sas~F: . . :.#a~..4:: mss .iG~l~l## #P## o p g. <br />' 31.~~/ ~RA;eI <br />cFFL'JLNC :,Ft75$ JALJF REQUIREMENT. O##? 13AI'y I1Y '1L/L lt08PR <br />)LL NJ ',N ,E SAMPLE 4R?R:#- r.R~r" 3r##F+~ >xr.'•# 4C ( I9) <br />~'' <br />~ MEASUREMENT <br />)37yt i 0 ~ <br />D' PERMIT.:'=r ~~~.. ##~'%x:: r: ;k .h?;c .~ .. ?#;: C4~i1 ;:r~^ -~ IO ~ f oYrIR' :R'~B ~?~ <br />,FF'i.'Jt:.t'_ :,RJSS yALJ? REQUIREME(J~L ;;,Lty. ... I>AIL~Y !7$ F!C/L 6F,&[ <br />• L ,., ~. CJR DO C J~'. SAMPLE ( 1JJ) v: FG-~~. .. .. .. ~.'?::Y <br />' .• J r .; n C.^, F V r P L A N C MEASUREMENT <br />1JJ)v 1 0 J ~ ~..;~LiM1T )PtIJN~AL~ '~~::PJi r >k~ar4-';c Y~+:=X:x 3 "..~..tslp;x# = Y,^• ( RC°/ ~IISl,SN <br />.:FLU~Ii'r ~ft]SS YALUE :RE.4.iIREMENT }pDA;}:Fo^: eJAILY I!$ ~CL '=:~C# <br />I"l~NTR <br />., A:+D .:flEASF SAMPLE #~h#Ca ( 91) ,-:C:= ~: ., ,''r ;: ~:`~k <br />L :JAL MEASUREMENT <br />;wUSD 1 0 0 ~ PERMIT... ~#{+Sf#~~ ~ R.SP3R1' Y ;'S=I ~k~Y~;x4#r i=~=r# .~3 ~ ~+~Y'~`;~•~a z #.-;.# ( LrCf'/ ~I~SIIAL <br />:FFLJtYr ,iR735 V!L'JE REQUIREMENT IihST "iAX HC=O :##•'f g:){~p? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT .~ <br />NAME/TITLE PRINCIPAL EXECUTfVE OFFICER 1 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EAAMINED MD TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HE11DN; AND OASED ON _ <br /> <br />ctiDhRYd A <br />I9UIISGIl MY INOUIM OF THOSE INDINDUALS IMMEDIATELY RESPONABLE FOq ' <br />OBTAINING THE INFOM/ATION, I BELIEVE THE SUBMITTED INFORMATON114 <br /> <br />/ ~ <br />I <br />. <br />S <br />~ TgUE, ACCUMTE MD COMPLETE. I AM AWARE THAT THERE ARE. <br />SIGNINCMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUpING ~ <br />I <br />r <br />rI/1.. n ! ~; ` `^ <br />' _ <br /> <br />• <br />CO F2 <br />esident <br />, <br />PRISONMENT <br />iNE POSSIBI <br />ITY <br />F FN <br />NO <br />8 U <br />S <br />01 MD 33 <br />SEE <br />C <br />f <br />/ n <br />0 <br />9 <br />2'i <br />4338 <br />Ol <br />04 <br /> <br />. <br />. <br />. <br />L <br />O <br />E A <br />IM <br />1 <br />. <br />10 <br />SIGNATURE OF PRINGPAL EXECUTNE / - 11 <br />TYPED OR PRINTED wd+~..31~~ ~ mr~erran..M ~mn w ~ rw. ~ re tlo"ooo <br />ywA/ <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER YEAR MO DAY <br />COMMENTS qND EXPLANATION OF ANY VIOLATIONS lRebrancs s// sttschments hirer - <br />;cPTLtAJLr; S7LIJS Lr.'SIr :AIi13J FJR L)-YR, ['J-rIR PRE:'IP iJ'r;r J,ruJc::L' 1'D 9URGEN ~F F~RD~^ RF,;~UIP';;';FY"S I4 <br />+~h;tC I.:~.1,D, P. o. SPJit~~AT;:4 !fAVA;;F.'1°Yr PLA!i DUE L-L-a9, <br />mey be used. <br />13295/97JH19-I2ti4 <br />L OF <br />~.. <br />i „ <br />