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<br />PERMITTEE NAME/ADDRESS (Irrrb ird~7Nsw/lsanon r/DyQfmmq <br />NAME .., ., . '. i. ! ~ I ~~ ~ '. <br />ADDRESS i t ~ ~ • - ~~ ~ ~ - ~~ <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISGHARDE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />7-J61 I7-191 <br />+PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM :. ':~ TO I • <br />/J/19I1 tlJ_9L rOLPRr /JB-?71 /IB-191 /3x31/ <br />Form Approved. <br />• ~ • ~ OMB•No: 2040-0004 • . <br />_ ~., ` Approvsl s~girps OS-31-98 <br />.. - I I .. . <br />NOTE: Reed Instruetlons het co ktinq this form. <br /> <br />PARAMETER !3 Ard Ontyl OUANTITY OR LOADING /4 Grd OnlYl QUANTITY OR CONCENTRATION NO, FREGUENCr SAMPLE <br /> !OB-53I 15b6/1 13BJ51 M6531 !5F'611 EX p TYPE <br />I31-371 ,W,, <br />yYpa <br /> AVERAGE MAXIMUM UNITS -' MINIMUM AVERAGE MAXIMUM UNITS lea-c:l 161-581 169-701 <br />.:, ~ SAMPLE .. ..... ... .. -...nt 1. ~] <br />(5 c'~I MEASUREMENT <br />I: ~`~ '? PERMIT t<L<v k,.s ,.: .:.:~C;Lh . ;,;:... .;#h>z## l.~ ' •.r -•p/ .. <br />'-' F :. 7 t': !i . ] / ~ ~ ~: ~r L • ~ REQUIREMENT 37 D ' f` l r) v w v v': / ` .. 1,. r . <br />, i ,• ~ l 4 ;'t " .1 SAMPLE ~ ) ~) ~ar;e## .. .- <br />I+ ~ 'i :. ; •I ~~ ~, q y MEASUREMENT <br />..1„: , '' '` PERMIT ~r) ; r "T T ~ ; n T 3 ?#A~4 ':.. y^ ;:r ... ... r ~, . .r , - ! <br />'~~;/' '" REQUIREMENT ~~/,•.^ )Y-; ;,y •. ;, v^~ <br />.1 i is ~ >r'; ^. SAMPLE .. ~ . ( ` + 1 . ±:y##O .. ... - <br />- ~~; T ~ MEASUREMENT <br /> <br />. <br />!i! /J7 . 7 '' PERMIT <br />.,.. ..,. <br />.. ... ? -- .wr,: <br />.. w.. <br />.,. <br />=YZC r#;-. ..~~,~ <br />_... <br />,. . ~~.;], .t. ,r.: <br />' - ~ 1 '! °. 1! I' ., F J i `.. '/ n f r REOUIREMENT ~ ~ y y ,' _ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> SAMPL£ <br /> MEASUREMENT <br />PERMIT <br />REOUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E]UMINED AND TELEPHONE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON ~ DATE <br />MY INQUIRY OF THOSE INDINDUAl9 IMMEDIATELY RESPONSIBLE FOR - <br />~ <br />~ <br />o+' OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />[? ICIIa rt I ' <br />~ 1 ~ (S <br />T <br />PE <br />RE <br />. <br />HE <br />A <br />~ ~~ <br />TRUE. ACCURATE AND COMPLETE. 1 AM AWME THAT <br />SIGNIFICANT PENN.TES FOP SUBMITTING FALSE INFORMATION. INCLUDING <br />' <br />" <br />t <br />( <br />VII <br />J: itnen <br />a <br />Manager THE POSSIBILITY OF NNE AND IMPRISONMENT. SEE ie U.S.C. E 1001 AND 3] <br />' <br /> ~ <br />~ <br />~ <br />i <br />~ ~ <br />~ <br />~ w ~ 510~~ <br />r <br />Fa~ <br />' SIGNATURE OF PRINCIPAL EXECUTIVE A A ~V ~ A YEAR ~1 <br />~0 DAY <br />TYPED OR PRINTED N <br />a <br />6 <br />n ~.o+lnl.n <br />aw.vr e <br />,nw, <br />jw <br />/ <br />wa.rw <br />n OFFlCER OR AUTMORI2ED AGENT CODE Y <br />COMMENTS AND EXYLANATIVN ur ANT VwLA nUna Ixererence sn smcnmenra noe/ <br />I. ... .r ) F ., r=. T~., ,-. ...., rt... 1 °r, -y ~-vc .pp - . <br />,. !. !H .f;. '. J 4• )~ 1:', ^l': j~°. l: ')' rt .r r.~T .-q %.~~r_-.-~ it ^L~(T •,q ../I r[' <br />.rY d f~,••r ~~n,a TT,. T.r-~. nT. yc ... ~T.,. ••c r <br />EPA Form 3320-1 108-s51 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ n n ~ f? / q p (•!l ~ 7 -1(13 ~ PAGE OF <br />