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PERMITTEE NAME/ADDRE550+d,4 fac6ieNer/Lo•aum IlDIH.rwO NATIONAL POLLUTMT DISCHMOE ELIMINATON SYSTEM /NPOES) Form ADPrOVed. <br />NAME ~: ~ ~ ~ r ~ ~ ~ ~ ~ ~ - .. ~ DISCNARGE MONITORING REPORT IOMRI - , ~ ~ - - - - OMB No. 2040-0004- <br />' /I-I61 17-191 <br />ADDRESS - ~ ~ : F - - - , ~ ^. ^ ] - / ~• ~ - Approval expires OS-31-98 <br />" 1 ~ t ~ ' ~ ~ ~ T 1 -, , ' PERMIT NUMBER DISCHMGE NUMBER - _ • <br />FACILITY , I I MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAV <br />FROM ' ! TO ~ ' ' i <br />•' ( ~1 ~' T - - ~~ r ~ ~ - ~ - ~ (1011/ l77-231 !14151 !76171 R8-191 !34311 NOTE: Read ilatrucUaR1 bdaa complstinp this }orm. <br />PARAMETER !3 Grd On/Yl QUANTTY OR LOADING !4 Grd Onhl QUANTITY OR CONCENTRATION ND FREDUENCY SAMPLE <br /> (46531 154-5! l38-451 ley-531 154511 EX DF <br />l31-371 <br />MNYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !87.61! 164-581 /59-)OI <br />.:. I SAMPLE ~ -` C. [: U ~: -~ ~ ~ ~ r <br />1 <br /> MEASUREMENT <br />'', 71~~ ~ PERMIT `(~r~.• :C. •: 't o>.: <br />.~ <br />r ~n .r. ..Y <br />. 'i. ~ ? .7 ~t' REQUIREMENT •C ';'•^~ 1• .p Iv x• •!~ .<:,. <br />l ~.~a ~C - SAMPLE ( 1) ~ ~ ~ <br />~ ~ <br />~ ~ ~ ~~ ~ ' <br />~ <br />41 <br />=;I "j• ,~ • ~ ( <br />. MEASUREMENT / <br />Q <br />00( <br />'J ( <br />O P <br />~ ~ J(I <br />. , <br />7 }. <br />7 <br />. )`!:' !. ~ PERMIT ?'t..'3aT lrrlr)•rt,j- @s`rtr:h!. A~::;.~:r.-'. a•'-"r<:yt, r:.s'Ly ^q <br />ter, i.: _ ..-•--. t'sl'I:: <br />, REQUIREMENT ~Qn„ 1V 'af~ir> rY 'r <br />. ~ i.y:. r: <br />TI :' : <br />--'~'-~= <br />t SAMPLE <br />MEASUREMENT r~:'.:::I:~~: 1 .. :;t ....,,. .. ., - .... <br />~ Ar <br />T <br />, L ~ 1 SJ <br />~r;-, i 0 •' PERMIT r:•::. . xr-: Y <br />- °'_ . ... rt. .. L,. y .IS <br />t~ <br />I - * ,' v l ~ - * REQUIREMENT ~ ~ ~ ~ ,/ e r <br />r r.r. ~- , <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 />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY ExAMINED MD <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br />1 <br />~ <br />h~Tb~ r' <br />1~ <br />1-~(t OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />. <br />1 <br />: TRUE. ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />~ <br />, <br />ff <br />i <br />~ <br />' <br />' <br />' <br />. SIGNIRCMT PENKTIES FOR SUBMITTING FALSE INFORMATON <br />INCLUDING ' - <br />; <br />0'l= <br />f~f <br />.~ <br />:: <br />O~II i°~fi' <br />f='1V11 . <br />THE POSSIBILITY OF RNE MD IMPNSONMENT <br />SEE 1B U <br />S <br />C <br />1 1001 MD ]] <br />'7v t <br />,? <br />!; /(:-^ 7 ~ <br />• e ~ <br />~ ~ <br />9 <br />- . <br />. <br />. <br />. <br />110 <br />1 BIONATDRE OF -111NgPAL EXECUTNE . . ~ e <br /> U.S.C. <br />1 <br />. Ih.r1U.r MW Nr~ rhrobr nMY YcAdr Bws to ro 110,000 <br />' AREA <br />TYPED OR PRINTED .oewmv/n.wlh,Ma+n..nrwere..rr8mmrn. rd6 Wrs/ OFFICER OR AUiMORI2ED AOENI CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION Oh ANY VIULAI IVNS lMererenCB a//IRIMmeDr9 natal <br />F <br />r F L. . <br />'r -e <br />EPA Fam 3320-1 108.961 Prstnous edtuons may bs used. (REPLACES EPA^FORM Td0 WHICH MAY NOT BE U6ED.1 ,, r / r . r, _ , _ PAGE . OF <br />~~ <br />