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1 <br /> <br /> <br />PERMIITEE NAME/ADDRE65 QsYiFrYlryNnr'formrr VDlpr.rD <br />NAME T . _. - <br />ADDRESS ~ I (. « l ' .. <br />r . u• ! .1 •~ j ' <br />EAGLET' <br />. ~. i .' <br />LOCATION <br />NATIONAL PDLLUTMT dSCHMOE ELMINAl10N nel'ex, ri•~'.'.~5, <br />DISCHARGE MONRORINO REPORT (DMR) <br />1I-16 17-f91 <br />~' P~IiINI NUMHER DISCHARGE N MSER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO OAY <br />FROM ~ ~ ~ 70 .~ ~ -• ~ I <br />nazis nazisi rz~-zsi ns-n~ LIB-39/ 136311 <br />Form APPro+,l I. <br />OMB No. 2040-OOU+ <br />~A~provel ~expire4k76~3 7198 <br />- ' j ~:'. <br />~~NOTE: R~ed'frietruetlom befas~oempueinp thle form. <br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !~ lSrO OMYJ DUANTRY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> 146-53/ 6461 13BJ6 llfr63 6L6F EX KY TYP <br /> <br />!3137/ M <br />~S E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UN175 yzr.T r6/-68/ 1s9-701 <br />`. r ,. .3 'r (, , f 1 ~-. SAMPLE .... ( r J) _ ..... .... , <br /> <br />1 MEASUREMENT <br />i • I rt <br />. <br />... .. ,: r .. <br /> <br />' <br />..PERMIT ~~ <br />.. <br />...: <br />.....:;:;;e'.gr~ <br />~ <br />":![P~'}.f::* <br /> <br />r:'.=; <br />~ . ~ <br />~. r:; -s,:~: ~~. <br /> <br />L#e:.^,.,~<.~~,= <br />. -. <br />r's:-:~:~~ <br /> <br />~~~ <br /> <br />... <br /> <br /> <br />i.~k~. <br /> <br />7j. ;91 <br /> REQUIREMENT <br /> . <br />, ~- <br /> SAMPLE ~ - ~ ~ ~ I <br />• MEASUREMENT / ~~ l,l ^~.~ <br /> PERMIT ~ ~.. ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> gEQUIREMENT <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 /> t <br />NAME/TITLE PRINCIPAL EXECUTNE OFFlCER I CERTIFY LWDFA PENALTY OF <br />AM FAMILIM WITH THE INFO lAW THAT I HAVE PERSONALLY E%AMINW MD <br />RMATION SUEMITTED NEREIN; AND EASED ON - / ~ I . ~ <br />~ TELEPHONE DATE <br /> <br />q <br />~ <br />' <br />' ~ <br />~ <br />MY INQUIRY OF TMDSE INOINDUAl4 IMMEDIATELY RESPDN9BLE FOR <br />I BELIEVE THE SUEMITTED INFORMATION I4 <br />OBTNNING THE INFORMATION ~ <br />/ ,' <br />~ <br />, [ 1 t <br />~ I <br />~ 1 ( , <br />T T <br />T <br />E M ~, <br />~ <br /> HA <br />HER <br />TRUE. ACCURATE AND COMPLETE. 1 AM AWME <br />E <br />INCLUDING <br />R SUEMITTINO FALSE INFORMATION <br />TIES F <br />P <br />A / ~ <br />r ,L <br /> <br />/ <br />Ef i 1 ~ ~ /~ <br />. <br />SIGNIRGMT <br />EN <br />O <br />L <br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.4.C. E 1001 MD ]] <br /> <br />g1pNATU1IE OF PRINCIPAL EXECUTIVE <br /> <br />~,~/ - <br />_ _ <br />~~ ~ ~ <br /> <br />/ ~ <br /> <br />~ ~ <br /> <br />I ~ <br /> U.S.C. E 1 ]I0. lhrWU•. InOw fbr NArha TIY NoYMr rYN t0 ro f IO,ODO <br />C <br />NUMBER <br />YEAR <br />MO <br />TYPED OR PRINTED w'rerrr•rwx.n NrairmwnrdbnrrnEmonNaAM6FwA1 OFFICER OR AVENORI2ED AOEM ODE DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRererencs an srtacnmsnts nere/ <br />• <br />-..i :I. ~. i_. 'l.i ~. ..J ~ ~ .. ,.? !.. .=. ~1Y ..r' ~ rt -. ~,i • ~' .'1 ~:~ - I .! i'-' <br />EPA Farrri~ 3320-7 fD8-8B) Prevlou4 edition3 mSy be used. - • • • 'IRE CE6~EPA FORM 7.40 WHICH MAY NOT BE USED.1 ~ ' - • '-' • ' • ' PAGE OF <br />, - 1 , , a l .' ~ ' ,i - I _ - ~ I <br />