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PERMITTEE NAME/ADDRESS Owelr4 FrNryN~/lacanm dD~inrl <br />NAME .. ~ •'I - .. ~ .. ~ ,. .. ~ <br />ADDRESS ~ ~ ~ ~' .I o -• - A .. ' ' <br />:~ -1- ... ' 7 L: <br />FACILITY <br />LOCATION <br />., i C'.. .- -. I T t <br />NATIONAL POLLUTANT DISCHMGE ELIMINATON SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT lOMRI - ~~ - - - -~ •-.~OMB~No ;2040-0004. , <br />l1-lel 117-191 <br />.• .. .. - I Approvd expires 05-31-98 <br />^PERMIT NUMBER DISCHARGE NUMBER - _ - ` r <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM ' .., .. TO ... ... . ". ., , - i -- I <br />!167/7 l21-131 11I-151 !14771 128-191 130-311 NOTE: Read IneEructlont 6afore complatiny this lorm. <br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !1 Grd OnlYl QUANTITY OR CONCENTRATION ND FREDUENCY SAMPLE <br /> /0453 l5b81/ l38-I5 4453 154811 <br />EX OF <br />l31-371 ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e1-e]I !84881 169-701 <br />i .. ~. ~ .. L : r SAMPLE ... r. ': ^ •i .. - ~, ~ <br />~•~ c-.) MEASUREMENT <br />4 .. ( ~ ~ PERMIT .. .. ~:: {s ... ~. . o :". .. . ,. ... 7 ~ r -r ~ r •• ~ : ~ .. <br />I I } .. ,. - .. REQUIREMENT _ ?I~ c r.. ] v - . T * ~' ?Y - ' , '.I <br />_G~A ,, '_ ~ ,. ^.' SAMPLE ~ T) :r: :r. r, <br />~' i - -- o ~ ~! i ~ : - MEASUREMENT <br />D1: ~: 1 !I ., PERMIT qc~.P ~]P,T )~^I3'iq I. ... ., r,.-: t:+: t; x.., qt. r, t: o .. ; rrVT.y ^rr`~. <br />~:' L L '.14; '~ REQUIREMENT '~~!.F 1VG ~j, c' M`F <br />~. •.. •/ .-.. <br />S •. ~ . ` '-'. ~ ~ SAMPLE ... ,, ..._ . ~ } ..-.. <br />/ T : • - ~ MEASUREMENT <br />II -. 1 0 .. PERMIT is AC: rr: G. r~ ~.[1 ~ ter.. +..y:l? ...f^ .- •q Ly rlv.lr <br />•, p Fr T G R ~ 5 5 REQUIREMENT ~ T^ ~ ~" C] •- _ <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 UW THAT I HAVE PERSONALLY E%M11NED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br />^~C~ <br />+1 <br />•C~ t <br />i~~~ EVE T <br />NI <br />S <br />ET <br />A <br />I <br />. <br />7 <br />1 <br />~ TRUE. <br />ACCURATE AND <br />OMPLETE. <br />AM <br />AWARE <br />HAT THERE ARE <br />C <br /> SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />IN[LUDING <br /> <br />F fIVIT'OTIpT lI •.~a~r: C <br />A/' . <br />THE POSSIBILITY OF R <br />MPNS <br />SEE I <br />110p1 <br />E <br />D <br />T <br />S <br />C <br />t}7Q b <br />~_Z ~JS <br />~ oo <br />7 n <br />J N <br />AN <br />I <br />ONMFN <br />. <br />B U. <br />. <br />. <br />AND ]] <br />610NATURE OF PRINdPAL EXECUTIVE I 1; p 'J it <br /> U.S.C. f 1]1S. lPrWFyr uWr uu~ ~YNNr rNrY AItA.d~ FirwaW ro !!0,000 AREA <br />TYPED OR PRINTED rW nnrrwNm l•.pAAmwnt oFMwwrl errlmNa rWe/vra/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO pqy <br />COMMENTS AND EXPLANATION Oh ANY VIOLA/ IONS lRe/eience e!/ sffec~menfs heFel <br />r ~ h ~ I • <br />~:. •i1 ~{ ~1• ..-.. _r __ r F 1. ., I. ... ~.. ~r ter: .f'r .....-• ~ . -_-- ~-. .... ;.,A r' -• <br />EPA Form 3320.1 108.961 Previous edltlone mey be used. T IREPLACE9 EPA FORM T40 WHICH MAY NOT BE USED.) ~ ., , - ~ ~ - /• ~ .. _ . ~ ., . PAGE ~ OF <br />