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PERMITTEE NAME/ADDRESS (/rW~FrWryNwWLorn,w BD,df.wp <br />NAME <br />ADDRESS E iJ d L C y J. 2" I '1 ~; <br />P.O. 6~C '1'Ii <br />PAOYIA =:1 'Il~l2''. <br />FACaITV Would ?°.°-~lld~ :.i, l._SiIi.i; <br />LOCATION <br /> <br />NATIOHK POLLUTANT dSCHAROE ELMINATION SYSTEM /NPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />rs- rel n 7-/sl <br />- PERMIT NUMBER dSCM/JIpE NUMBEA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ,I ~ ~ TO 1 <br />/JhJII tlbJal /JLJ51 /JA-JJI 19AJ01 /Man <br />^0;"i D U5C11. TO <br />(so!•r. uc~ <br />F - FINAL <br />`tItin~t <br />Farm Approved. <br />OTMpB No. 2040-0004 <br />cwpprpOVe~~ezp~ree-0~~~ I98 <br />1?33 ) <br />'.1 •.._ fir t-TCCY )'.- .. .. <br />NOTE: RuA in~tructlone `~i1or~ eom~letina this form. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION NQ FAEOUENCY SAMPLE <br /> <br />l32 <br />37 !45.531 15~-5/1 138J51 1~6-531 15I-511 DF <br />- <br />1 EX NKrss TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsa-eal A <br />154-581 159-701 <br />JI:. AyJ ~:d'AS: SAMPLE .;-,F:r# ( 4U) Ok~44:. :::f,: !e :;: :>a <br />'' <br />i I .; J n L MEASUREMENT <br /> <br />ctuJ;,b 1 U U <br />. PERMIT <br /> <br />REQUIREMENT <br />V,r.C?~S: <br />'i'I:L?JRY 1 <br />ES= <br />L:a::a5:u <br />#~vC a <br />.. ~ <br />~r~FC.. ., <br />nk. <br />p, ', L Y Y I~511 A 2 <br />, <br />I - N ~ _. ,. r „ . . <br /> SAMPLE ~ -~ <br />• MEASUREMENT <br />~ <br /> ..PERMIT ~ ~ ~ ~ ~ ~ <br />~ ~ ~ <br />~ <br />. ~~ <br /> REQUIREMENT ..~ ~.. :~~. .~~.~: ~ .. . C 1~: f ~ _ <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEli1TLE PRINCIPAL E7(ECUTIVE OFFICER I CERTIFY UNDER PENKTY OF LAW THAT I NAVE PERSONALLY E%AMINED KID TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND 9ASE0 ON <br /> MY INOVIRr OF TNOSE IHDINDUKS IMMEDIATELY gESPON95LE FOR ~ <br /> OBTNNING THE INFORMATION, I eEUEVE THE SUBMITTED INFORMATION le <br />TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE APE <br />SIGNIFICANT PENKTIES FOR $IIBMITTING fKSE INFORMATION <br />INCLUDING <br />/ ~. <br /> <br />h ' ~ ~ <br />1 ~I / ~ , <br />THE POSSIBNTY OF RNE AND IMPRISONMENT <br />SEE 18 U <br />S <br />1 1001 AND 70 <br />C <br />~ 7 <br />~ <br />~ ~~ / <br />/ <br />~ . <br />. <br />, <br />. <br />U <br />f t Ste <br />S <br />C <br />IPrWS. ullr n <br />b1 <br />lraa <br />Y <br />A <br />d <br />5 <br />T/O SIGNATURE OF PRINCNAL EXECUTIVE ~ ~ ' ~ ~ , <br />T <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />Mw , <br />l <br />ANY <br />I[ <br />1 <br />a <br />w, ye ro <br />,OOa <br />.ra rmuinun inplaemrlr of Nrwwn smmeta rM SYrAI <br />OFFlCER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />L,ummcn I a Atru t:ArLnnw nvn ur nrrT vrvl.n I lvna Inerersnce Im erncnmsno ngel <br />.,;ILEAwL6 SOLIDS LI"1" KPPLIE'.~ J~L'i IF := 17-Y 1, ?4-!iF; ?F6,::L' ,.Y:aI ~~ ''LAI''cU. IF CLAI' IS AP~h~uF.J - <br />• ,: a~CUF T53 ~ I9Jfi LL'IIiS BILL \JI d? AP^LI':D -"D rFPJ3.IF;D .iL.A~UiLt:Ic.dl'S -S F, E' I.°.lAE P"; > .A.`!U i.~,1:,F P-, <br />E17A For - I 96 ' e " b 16oh ey d. ~ -1 FACES EPA FORM Td0 WHICH MAY NOT BE USED.I PAGE OF <br />