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PERMRTEE NAME/ADDRESS /Gd+/I F~rlaryNar//aauaw lJDld.rO <br />NAME , <br />ADDRESS ! . + n ~ , . ~ - ~ I ~ I ^ <br />i" . .. ! <br />FACILITY , , .. ~ - - ~ L '' <br />LOCATION <br />J c!v. <br />NATISNAL 6d4trvwty Ta6t.APCt EIJMINAT,,,~~ee ''iT`EDf 4LIYUtJ/ <br />DISCHARGE MONITORING REPbNI{ IDM%11 ~ ~ „ _ ~ r „ ONIB No. 704V-w i + <br />7-161 lt]-191 [~.'. ._. I. w. `' i <br />.. ,t ~ ; .` : _ , „,..: , ,. a ~. Approval a iree 05-ai-SS <br />PERMIT NUMBER DIS(HMGE NUMBOI S ~ - ~ 1 ~ I ~ <br />r - <br />~' ~ ~ MONITORING PERIOD ' <br />YEAR MO DAV YEAR MO DAY <br />FROM ,.. TO , - I .~. ; - ... _ ~ -- I I <br />174311 l77-731 124751 rz6-?71 aza-19l a3431a NOTE: Read 7ruwetlaFr balor• comPl•tinQ Thh fonn~~ii~ <br />PARAMETER !3 Grtl OnNI QUANTITY OR LOADING 14 Grd Onlyl QUANTITY OR CONCENTRATION NO. FAEGOENCY SAM E <br /> /46-531 l5b671 /38-451 f46-53 /50-6'I EX OF <br />137-371 <br />MA1Y515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lap-a,Tl lsr-6g1 /69701 <br />_ <br />., SAMPLE <br />... - <br />.... .. .. <br />.. ~ / 7 1 S ~r <br />, ... MEASUREMENT ~ <br />' ! <br />-I <br />I i , <br />J a <br />I ~ <br />L <br />~ PERMIT .:s :. ;a:: _ ,..~ • ' ., N'. 7:X~ :~ : 1 ". a °. ~ .. -~/ '.S;? i 't." <br />. REQUIREMENT <br />' <br />f,; 1~. <br />~e ~, Air <br />+ <br />.' it <br />; ., . <br /> SAMPLE ~ : _.: •` r::: ,...: -, ,•::; • <br />>': <br />F <br />~ ' . MEASUREMENT ~~ < - ~ '~ ~ <br />S <br />i G / <br />,.. 1 PERMIT 6 4•.jZj `{>u'?I S;{T fi:^. iz 7%s i:• :~:" ti`-~ -mot t".`.~Li 's'S ~'.. <br /> REQUIREMENT <br />- - <br />~ : <br />~~ <br /> SAMPLE ....... .e:~ :,: :...:.:. :. .. ..: ....: , <br /> MEASUREMENT ~ ~ <br />~ <br />~ / <br />' <br />~ ^ u '~ ':, f tf <br />I~ <br />l; `1 G +,-'.e L.. .... ..... ~,~ <br />~ v~ / t .Y~C c'I~ in~F <br /> AEQU REMENT . <br />i~ ~~.I, )'i7 ~i ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUTAEMENT. <br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CFATI FY UNDER PENALTY OF L AW THAT I NAPE PERSONALLY E%AMINED MD - TELEPHONE DATE <br /> AM FA MIUM WITH THE INFO RMATION SUBMITTED NERON; MD BASED ON i <br /> <br />1 <br />~ f MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATO.Y RESPONSIBLE FOR ' <br />1 <br />J' {• •^ , OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />~ TRUE. ACCURATE AND COMPLETE. I AM AWME THAT THEAE ME <br />SIGNIFCMi PENALTIES FOR SUBMITTING FKSE INFORMATION <br />INCLUDING 1(. .', ~ j' <br />! / ~ 1 , <br />THE POSSIBWTY OF RNE MD IMPRISONMEMT. SEE I• U.S.C.) f001 MD S7 <br /> <br />BIONATURE OF PRINCIPAL EXECUTIVE -. <br />!/ <br />/ ~ <br />• : / <br />a ( • <br /> U.S,C. f t11•. fPwWe~~ urMr tlwr rtrAmrA mry Ache ara Ip ro i 10,000 AREA <br />TYPED OR PRINTED eM amuim.n Alwn'anwerdbnrwn awanNa rK6YAVal OFFICER OR AUTHORREO AGENT cOOE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS aR•Tersnc• sll stfechmenv hWe/ <br />EPA Form 3320.1 108.961 Previous adidorre may be used. IREPIACES EPA FORM T-40 WHICH MAY NOT BE USED.{ PAGE , OF <br />