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PERMITfEE NAME/ADDRES$pnctude Facdiry Namellocalion fDiJjerenq NATIONAL POLLUTANT DISC <br />NAME LwIhREC, IIrC. DISCHAq GE MO. <br />ADDRESS ,yC FT h' THCCFSCF CFFEK MIFtS I-~ %~° <br />17otl CCMFASS CFIVE, SUITE 1G1 PERMIT NUMBER <br />FACIU7v GAANL JUFCTICF CC t1.UF, MON <br />LOCATIO YEAR ' O DF <br />NCFhHChG'ALE Cc 61E23 FROM ' <br />A'ITN: J. k. S1CYeh, CONSULTING ESC. (zo-zt) (zzzs) rza, <br />.E EDMINATION SVSTEA <br />RING REPORT (OMR{I <br />DISCHARGE <br />ZING PERIOD <br />YEAR MO <br />TO 1. <br />(NPDES) Form Approved. . ' 1 <br /> OMB No. 2040-0004 <br /> C I 4 C n ~F <br />roval expires 05-31-98'~~ <br />A <br /> pp I k <br /> (sueH ic) ~ <br />' <br />IUMB R F- F I F l i N A <br />F! T <br />;;~- cHFCFIC i.: .,,-~,IFC FcF cclF <br /> . e <br />rco.3U NOTE: Read Instr Z~ompleting this form. <br />uctions befor <br /> (3 Cercl Ony) QUANTITY OR LOADING (4 Certl Ony) O ANTITY OR CONCENTRATION NO. FFEOUENC SAMPLE <br />PARAMETER (as-58) (54-67) =- (38-45) (<s-ss) (54-s1) EX of TYPE <br />(32-37) AVERAGE MAXIMUM UNITS. ~ ' INIMUM AVERAGE MAXIMUM UNITS <br />ry7t~al ANALYSIS <br />(6a-68) <br />69-70 <br />aF•FF'F:CT STAThE 7GA.Y <br />- SAMPLE <br />MEASUREMENT „~~•'~~~ Y:aaalo ~~UU ,,,, ~r><i;alts ( ;;;) ~q~ ~~ <br />l <br />flh CEhICCAFHh IA ,I <br />'fCYj;1 S 0 G --.PERMIL` a9AA~~ '.-o4-~Aas~''. t.:. + <br />~ <br />~ ~ z (R~+qO# <br />~ '!~~ ~=ICF! - EF- = :SE'L~"-. ~~ <br />SEE CCCMF~FTS tkLCa :-REQUIREMENT ~ ~~- ~,, °" ~ ~ ;4,;.,: ~ <br />CY'~ ~ <br />x> CEF <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ._ ,ti,.~- c;_, ,... .,,, ~_ .-:. .: ,-.- ,K ~rt~~ <br /> REQUIREMENT ~N. - ~~ ~. ~^'~£ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~„~ .:~~ c±~.,:.-. ~ ~,: <br /> REQUIREMENT ~. ~_ ~:,~;; „, ..r.. -- r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT- ~~5. - - •. - - -- ~ ~- <br /> REOUIREMENT ~F ~ ;',~'_- ~ '~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />-~- !.fr <br />~'~ <br /> REQUIREMENT - <br />~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~~. <br /> REQUIREMENT ,;'~ rr °"~~• 'f "." <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' { ~"_.-: . W <br /> REQUIREMENT ~ "~ - - - <br />• <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />V TELEPHONE DATE <br />J' ~ ~ f _ ,I~,7 <br />L <br />l-Ify`.(lY V AM FAMILIAR WITH THE INFORM <br />INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BELIEV ATION SUBMITTED HEREIN; AND BASED ON M <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />_ , <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br /> <br />2 ~j PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />POSSIBILRY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. § 1001 AND 33 U.S.C. <br />/SIGNATURE OF PRINCIPAL EXECUTIVE <br />9~ <br />a9s - ~o/ <br />06 <br />D~ <br />c <br />TYPED OR PRINTED me..im mlPmpnsmmerrt of Duhvee n6 meonN,v entl5utl~~i BS up to E10,000 entl w OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY. VIOLATIONS (Reference all attachments here) <br />:,t[i 1.H.5 FOA TEST FF.CCkDUAE. 6PT RESULTS CF LE7tALITY CEi,IYATICS~ A. ";EFFECT", CFCi1F F FFIFCCLC77CF <br />L~h:nIYATICNS AS °TC7I]C1TY". FPT COYEST X EFFI A7 iFICH STRTI"_TICAl1Y SIG9IP GIFT EFTYEEF 7FST E CC N7FCI <br />EPA FDrm-3320.1 (0$-95) ~P~revious edition`s may no be used. ~ (RAP ~ ^O~S ~E~A` O M f-d0 Hl~~i )L}AY NOT 61= USE .)` " ~ ' ` ° ~ ` ` ' `' dGEt ` r <br />~CCC53/99Ci1:-11C5 1 <br />