PERMITTEE NAME/ADDRESSpM:4 F~WyNr/L«mrm l/D~...q
<br />NAME ~ " ' - ~ ~ - •- ~ n
<br />ADDRESS ~ ~ ~ ~ o ~ i i . r ~ . ' ) ..
<br />..11.1 -,~-• '. 1,' -
<br />'. , .
<br />FAauTy
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNMOE ELIMINATON SYSTEM (NPOES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMRI - -:~ OMB.No. 2040.0004
<br />11-161 I7-191 '
<br />-,-. r , - ~! - . ~ ~. ! Approve) azPirps OS-31-98
<br />PERMIT NUMBER DISCHARGE NUMBER ~ .
<br />MONITORING PERIOD '
<br />YEAR MO DAY YEAR MO DAV
<br />FROM . , TO _ . .. .. ..
<br />!1611/ l11-731 !14151 !16771 r18-191 l3631J NOTE: Raad Inetruetions beior com atinq this }am.
<br />PARAMETER 13 Grd Ontyl QUANTITY OR LOADING !4 Grd Onhl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146-531 1545/1 138-451 146531 154-5/1 OF
<br />l32-371 EX
<br />ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-say 164-581 169-701
<br /> SAMPLE . ., c r: t ' ; .a : - ^ 1
<br /> MEASUREMENT
<br />I'• . I~ .. ~ PERMIT .. .n -: rr; ?r.;rs'<e: r . r
<br />.' :-r. .. f' t
<br />i'. ..~" - ~ 'r ,la REQUIREMENT .. - ->i,-r •te .~.- -
<br />~
<br />- •r:,f ~.! SAMPLE t::t... ., .. .... ~
<br />, y~
<br />I; , " ; . .:. MEASUREMENT
<br />_ - I '~ PERMIT ¢:':a ¢ss ..°t F, ?: r: ~.. Yt r i 's -'c~~r :!-[:7 •:+ Tp^ t.^^^ r v^z~! ~r^y^
<br />f"j••.. ^_ a•.(•, REQUIREMENT ~~~.:: -jnn,r ]p~ r•,.+te ., ;r 7l an,ymy
<br />-.•,I.:A ;I''- SAMPLE ~ n::^`. ( .,~
<br />. ~. I'.:~ MEASUREMENT
<br />~"~7( 1 O ) PERMIT i:~.•~gy:Y ':r~;: r:±: r ~ ': •,. "C Z r . ,:/ ,r.~r
<br />',`:Iii GF~^. ;a .'
<br />' REQUIREMENT ~-^`r 7' ^.''i
<br />• •• ./r a~ T
<br />r '~
<br />. .
<br />`
<br />,~7:.: .)=~ -^TTL?~ r SAMPLE ~ .i.;:¢': .: .. ., i ` ,i
<br /> MEASUREMENT
<br />JL ,r: ,. ft ~ PERMIT .~ ?r. ..KF i-r:. :reR g , ... ~ - ~.~~ -- -. r :C' r
<br />NT- - REQUIREMENT r.7`•.: it ,. I r~ r•, „y ,~~ , /, I, •,
<br />:I;.. ~ ..~:?'[. ,t SAMPLE .._ ^: r: :r:; ~ ~
<br /> MEASUREMENT
<br />
<br />
<br />I PERMIT .. ... :[• ;ra; t:c r: .. .'<< .. ... ,,,y, _ ;.n
<br />
<br />F~
<br />• r .r _.~ -.
<br />,
<br />,- ^" ~
<br />' ,-! 'I
<br />' REQUIREMENT r•.-it •Ir ~ ,r ! :; ^ nF
<br />> ,r ,.
<br />.
<br />. ~
<br />! ,. ? u ~' SAMPLE •:rtni r..: ... ~ ~ ... (
<br />O\
<br />_ ., y - ~. ,. - ^, - " ? T _ MEASUREMENT
<br />", • .~ f PERMIT : r; r: ^: • 1 'y (::` r= •. .. .. ; ,^..:-•. .. ,....... t •+, / `1 ~ •. ~ ~ c.
<br />'~. D~~ ~~ ~~ ~^ T ° ~ - REQUIREMENT. T,•• •~
<br />'!
<br />/
<br />r -
<br />~F -.. ... SAMPLE - ~ .~.i .. .. .. / ''i
<br />`^. F-I MEASUREMENT
<br />J1 .L.' .) .PERMIT ::: r: r,, •x r,- :~C~^C•~;r ., ..... ._ ..r. .... - ,.,,
<br />/
<br />1;
<br />- CG.' ° ' : '. REQUIREMENT .. ~ ~ •. { •.n -~ y n - ~, " r+
<br />'f:
<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENU7Y OF UW THAT I HAVE PERSONALLY EXAMINED AND
<br />MILIAR WITX THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON TELEPHONE DATE
<br />`
<br />D rd
<br />I~IC
<br />~ lll$ ;
<br />R
<br />IIA
<br />I
<br />~
<br />E
<br />E
<br />:I
<br />. OBTAIN MQ
<br />THE MFORMATION,
<br />BELIEVE
<br />Sl1BMITTED
<br />TNE
<br />NFORMATION
<br />S
<br />f,~
<br />~nvlronc.~-it~I Y8'7)` ~r
<br />' I TRUE. ACCURATE NID COM0.ETE. I NA AWME THAT THERE AqE
<br />SIGNIFCANT PENALTIES FOR SUBMI7TIN0 FALSE INFORMATON
<br />INCLUDING '
<br />7FYI - ,
<br />THE POSSIBILITY OF NNE MID IMPWSONMENT
<br />BFE 1B U
<br />S
<br />C
<br />! 1001 AND ]] n7c r7[]_~753 T 7 ~~ 93
<br /> .
<br />.
<br />.
<br />.
<br />U
<br />S
<br />C
<br />1
<br />t
<br />M
<br />4 SIGNATURE OF PRINCIPAL EXECUTNE .
<br />
<br />TYPED OR PRINTED .
<br />.
<br />. !
<br />]
<br />B. I
<br />Wr
<br />. vW~r N.r mllmu nNY 1nCM~dA AMa Ip b f 10.000
<br />AM armv4rNnl inAVlAanwnr orMwwn emonN. rweYAerA/
<br />OFFICER OR AUTHORIZED AGENT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAV
<br />wmmcn I a nlvu cX.rLfLnA I Ivn vt• nlrT vlvLn I Ivlvo Irnrsrence an srrscnmenrs oars!
<br />_ _ _
<br />r ~
<br />i v r r~ ~ r f
<br />EPA Form 3320.7 108.951 Prevloue edltlone may be used. ^ (REPLACES EPA FORM 7.40 WHICH MAY NOT BE USED.1 ~ , , 7. _ ~ ; PAGE OF
<br />
|