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PERMITTEE NAME/ADDRE55pMrf. Fku~y.Va/ls.uw l/D~.r..rl <br />NAME ~ I . <br />ADDRESS - i P ~ ~ ~ - ~ --~ . ~ ~ - <br />FACILITY <br />LOCATION <br />.. 'tl' _ '.-- F .. . Y <br />NATIDNAI POLLUTANT DISCHARDE ELIMINATON SYSTEM (/yPOESI FOEm ApprOVed. <br />DISCHARGE MONFFORING REPORT (OMRI v , .. ,. _ - . -.OMB No: 2040-000,40+• <br />11-161 117-191 ' <br />-. _ „ ~ ., , . ~, ! _ .. Approval expires 05-31 ~98 <br />PERMIT NUMBER OISCHMGE NUMBER - <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ,~ ~ TO ,. .....-. ~ I •i: <br />l1P7/I !II-I31 !74251 !16171 178-191 !3631/ NOTE: Raed InetruetiaM bslo co Slop this }orm. ~. <br />PARAMETER l3 Gte On/yl QUANTITY OR LOADING /I Grd OnlYl QUANTITY OR CONCENTRATION NO, mEQUENCr SAMPLE <br /> 146531 (54611 l38a51 !16.53 154-511 <br />EX of <br />I31-371 ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sa-ss~ I6q-661 I69-701 <br />.I. .' JC'_'-r SAMPLE ':a :.i: c:: .. .. r. .. ... ! . t. <br /> MEASUREMENT <br />.lin~: I: ~ .1 ~ PERMIT ::} :r.: ~, 'r .. .. .. r.T -• ., ~ / ~ / ' <br />. ~ ~ I ' r . - ^ ~ ^ i REQUIREMENT •: r ~ T ^ .. p . ~c ~• • . r t Y y~~r ~ n <br />' SAMPLE ~ ~ ` .t ,t ~:~ a .+ ~ ~ ~ ~' <br /> MEASUREMENT <br />J"l. 1 L I' PERMIT ra :g rta pr,. -:G;.'<y 5.` ~ ..°Fv ,.: ,. <br />." c~- -I ./ <br />._ .- ~ :,: '~". '' '.: T REQUIREMENT "T N7H••v ...F.~~T..,r. <br />~~..1 -., J_t! SAMPLE :: t:: ': t: .r / -) <br />~J! '~ ~ ; ~ ~ '~ MEASUREMENT <br />~!1 '? 0 T PERMIT '?C•4r.~:. .,-:a..r,._.., . r...: .. ... - n,•,-~ vr>>:n~ :v: <br />- ~'i;4I`i:4T5 REQUIREMENT -.~ ..t.. ,~. ...y ,/-, ,,~r,Tw <br />i '..~SF 'I TAI. SAMPLE ~ .: ~- ~' ~ / <br />..- ~ ~ ~ MEASUREMENT <br />C: , ! ~ J ^ <br />' PERMIT: ~ ... _ !t Kt . -, r: .. ~ r, ~ '• , f ?' / ~ p 1>, <br />F.'t - ~4"- REQUIREMENT ~ „. ~~ ~. r t' •v - <br />-.I~y '.. ~F :,a ~i ~ SAMPLE ~ ... ~ .-r- ~ } ~..1 <br /> MEASUREMENT <br />_ .a I t. ~ PERMIT ... :. r: t: Y: q; ::. ': Ki:'. <br />.. ., .... <br />.. ..^pr," L' 'n, ~r <br />, ,Tr. <br /> <br />-- r•J; ,. - <br />REQUIREMENT <br />r: ••. .. <br />Zr, r.~ tr^ <br />,ITT <br />. <br />-r/~ <br />qr" <br />.l'..,Jti. "r. ~ ~ SAMPLE c~•t c: ~: :z.:':' .. ! .t~ <br /> MEASUREMENT <br />.'~I,. . C PERMIT `;n nr,n ~: rt:; ': *••.'. .. 't'.. "~, r, ,- +`:. ti.... :r. / , <br />..' L 7 - , •, ~' . - _ t' REQUIREMENT . ~. n ~ ~ ' . +,, ... / „ y~ / . , <br />J_L .:.~ ... ~ SAMPLE r.e ~. ~.~_ r. .:.,. ~~- .. r -r <br />~; ', ,.,, - ~'' "'• MEASUREMENT <br />1 ~ `.4 ", ~~ ` PERMIT .. : a . .. r,. ~ ~ , <br />. .'I ^. .' ; ., . _ :' I I. REQUIREMENT .. ~ ... +. ~ .. ,. / •, <br />NAME/TITLE PRINCIPAL EXECVTNE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR NrITH THE INFORMATION SUBMITTED HEREIN; AND eASED ON <br />L,'Vr~_~ fl ~.~'~~ MY INQUIRY OF THOSE IMDIVIDUKS IMMEDIATELY RESPONSIBLE FOR <br />i OBTNNING THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />Fi1~/IPOiI P,r,: rt T~ ;i7 •l3 nl:I'• <br />') TRUE, ACCUMTE AND COMPLETE. I AM AWARE THAT THERE I1RE <br />SIONIFCANT PENALTIES FOR SUBMITTIND FALSE INFORMATION <br />INCLUDING . <br /> , <br />THE POSSIBILITY OF NNE AND IMPN <br />MENT <br />S <br />1 <br />E 100 <br />S <br />C 9 / 1 ~ / U-~ ~ ~ j '{ z 7 ~ L <br /> <br />. <br />SON <br />B U. <br />. <br />. <br />1 AND 4] <br />EE <br />BIONA7URE OF PRINCIPAL EXEQUTNE , <br /> U.S.C. 1 13t0. lPUWar. urNr IMw moms Itr.Y hrcA.O" nm" w ro SIO,OOD <br />TYPED OR PRINTED .rrl a+muNN.n inprisrvaw+rP/Mnvwn smonn. nrs6 Yrra1 OFFlCER OR gUTHOpIZED AOENf CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANr vIOLAT1oNS /Reference sn attecnments oars! <br />s <br />rr <br />EPA Form 3320-1 108.961 Previous editions may be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.1 ,, r .. / - ,, ,. _ PAGE . OF <br />:~ <br />