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PERMITTEE NAME/ADDRESS p+d4FsINryNwdLeearion!/pl~.wl <br />NAME tlV Lrw ~~ I'Ilc T.S (, IJwT.r ~i i~~,+ <br />ADORESS~L:u111FItLi1 niNE <br />i01 ~. IJA(Uiv uLVu. F Sl:l TL 4UL <br />L ARi_'n :; l~L' (.u J113~Li4if9 <br />FACILITY CN[n.,Y f UCtS lL1PL r Ilrl. <br />LoanoN~Lu~,crlCc ~U c~<Z6 <br />Ailiv JIi I~'.L~ T+ Lli 1, 1'C:c+ JI'-UF'tl{A )•T1i 1115 <br />1 ~ ~ .~ <br />NATIONAL POLLUTANT DISLNMOE ELMINATON BYETEM (NPOESI Form Approvsd.a ~ y, <br />D16CFUtRGE MONITORING REPORT OMR1 ~ f~AB ~lo. 20.~O+A0004 <br />1-151 I7-YY91 ALU TI NET TC.5T Ii14 Jl+. <br />r ., App'fovel ex vea 06-31-98 <br />ELI Lirt ]c I~~41 <br />PERMIT NUMBER DISCNMGE NUMBER ~. ~. I ~ r L , <br />. <br />MONITORING PERIOD ~' I' ""' <br />YEAR MO 'DAY YEAR MO DAY ~-,,.,~ <br />FROM ~ A TO '3:; i,o ~U #••+:' i+!_ .Ji ~(, riA~L,c akyf <br />174711 l77-131 f7<-15/ r26-771 f18-19) r343r1 NOTE: Reid IrntructlaFU bHon GomplNlRp thle form. <br />PARAMETER !3 Grd On/y QUANTITY OR LOADING <br />~ 1<Grd Onlyl QUANTITY OR CONCENTRATION NQ. FREOUENLI' SAMPLE <br /> l16-531 15451 <br />~ f3B-I5 1<653 ~ 151.51 OF <br />l37-37/ EX ANALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rst-edi fs<-5Rl lSglOl <br />-l.~_ ~Tdlrt:_ `+dlik :.c.U 'SAMPLE 4ir4$+r4 vOk#>a•x #R'4+F;.p .;.~Ky,tv.: ~; ' <br />C_,,IL,,,Arnf,id MEASUREMENT - ~ /1~Q ~rL.l cjrn~. <br />dL ~,= 1. ~~ U 7.;:;2PERNIIT:j::'~ :'.':#o~''r;~( ..~..i ~: y,:..!iLlail~Y~ir1¢!y1.F'i~.:,}t 1". ,.....:":':::~:..:~:.~~:::.::. :'.::1iF ."iR~..::::':: :..,V~~L:~':::.',.:::..~, __F - ..: ~ .: <br />- ~: r' s :REOUI9EMEN7:: :.....':~....... <br />,.. .. <br /> <br />~ <br />-C::~ ~TaTr~ 96nr, dCu SA.MPIE {rp.pyyf!. f4#p~pa <br />4k##N~ <br />i-v•,. %e •, ;• <br />~ <br /> MEASUREMENT _ r' ~ <br /> <br />d,.c~ i. <br />l: v ~.x:XS.".F: RMhT`::;4.( <br /> <br />"; l?pwx'''.:'.. ~".. .d. ~':..~.... .:.rTi''.:;`~ <br /> <br />Y:Pi <br />.. . <br />: '{~:-'~!~. 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'REQUIRE131ENT: . <br />,. <br />r... ... ..5 <br />:~~ ~. ,:~ ~~. w;:.. ~::;: , <br />:.~ <br />^:::: : <br />...:.... <br />:c..y.y,. :.: <br />:r <br />.'i:.. <br />:. <br />: <br />:Ci <br />:: <br />:'>.r'.: . .. <br />. <br />: <br />~,,.t: ~:;:~:'.'::g.%~:' <br />,,:' <br /> <br />:'. . <br /> '~ SAMPLE ~ '^'~~ <br /> MEASUREMENT <br /> -,~:+r ....:PER,-~:~:";: <br />sREQU1RE <br />' : <br />ME :~":; ,:- . .. <br />, <br />, <br />:> ~::: <br />•:: <br />: . ,....:::'.. <br />....,.... ..:. <br />. <br />.: <br />.. <br />: <br />: <br />'- - <br />.; <br />~~' <br />i:~~t~ <br />..:.'~ <br />. <br /> . <br />,. . <br />.: <br />. <br />. <br />: . , <br />,. <br />. <br />:. <br />: <br />. ~ .:. <br />..... . ~ <br /> .' SAAAPIE' ' <br /> MEASUREMENT <br /> ;.: <br />'- <br />;:... . <br />' <br />' <br /> <br />. <br /> EnLi! .' ME . .. <br />.: <br />,::.. <br />,::: <br />, <br />.. <br /> <br />.:::',. ~:..... <br /> SAAAPL <br /> MEASUREMENT <br /> -~~..PERMIT..,~ ~ <br />~ ~ . <br /> :REQUIREM.ENT~: ~ ~~; .,..::: :•. ~ ~~ <br />:. .. ~ .. . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT - <br /> _::. PERMIT:' ~..: <br />: <br />~ ' <br />~ .. <br />~ <br /> ~REQIIIRENIENT':. ::..: .:: <br />, <br />.. .~' .~ <br />~ . <br /> <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />MILIAR NRTN THE INFORMATION SUBMITTED HEREIN <br />AND BASED ON TELEPHONE DATE <br />_ II r..! <br />~ / TLfL1TC -yL <br />~ .i ~ 1::1 <br />/-, ~,_ <br />/r ; <br />Mr INQUIRY OF TNOSE'INDIVIOUALS IMMEOIATELr RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFOPMATION 19 <br />~~ I <br />__ <br />. TRUE. ACCURATE AMD COM0.Ef E. I AM AWARE THAT THERE ME <br />$IGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INLLUOING :,J r `' - I f <br />'y-"- -7 ;~- <br />7 <br /> <br />~ <br />1 <br />~ <br />~ r <br />~ <br />l i , <br />THE POSSIBILITY OF HNE AND IMPf1150NMENT <br />SEE 10 U <br />S <br />! 100 <br />AND G3 <br />L " ~~ ~ . ~~ - / <br />~ . <br />~ <br />I i\ ~ / . <br />. <br />. <br />. <br />1 SIGNATURE OF PRINCIPAL E7(E ~ Z `~ ~ <br />~ - <br />/ % <br /> U.B.C. ! IGIB, rA,Wd++uM+r Nrw mruna mFV icAd~ r•,F+Nr ro 110,000 CUTIVE <br />TYPED OR PRINTED And n,rr+i,x+n Mnpr/wmiv,t olMmw, BmmN+AMb y+v+l OFFlCER OR AUTNORfZED AOENi CODE NUMBER YEAR MO DAY <br /> <br />.~c L.A..:r <br />r~. `: F f:.: <br />7r ~h. ..c L~ ur <br />T T wL.t J.:n~~. nrr`I,nT <br />~., -, u,_.. - .IT~;TIi(Iu::L. I•~_:.I -. ,;fi,:+Tc n'~ILr. I~ <br />~:.in~~ 1,, ?'I. ,.r Tt:.i :,ntr A;~: Sii~r :.i~J .iTld~-n .. (.U l~c T.I /,1l.l TY TLS( r,~~'.~:T f~-..• Tu ;Its <br />. <br />~ l: 'n L <br />• qL <br /> <br />, T I <br />A . ,. <br />. r T T. - r ,. <br />. .. , <br />L- <br />EPA Form 3320- 106-961 Previous aditionB mey be used. IREPLACEB EPA FORM T-40 WNICN MAY NOT BE USED.) PAGE OF <br /> <br /> <br />