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PERMITTEE NAME/ADDJ1E55 pxWdrFrmryNrWlorn+m +JDlpnrp <br />NAME <br />ADDRESS N O ~ I G . ~ ) . ° ! :. = <br />P. u. f1Jf 1~;7 <br />PAU.cIP ::p 91JL! <br />LOCATION F I. 1 ~~ I T .". 0 <br />tTPh: aLi. ..I A" ~{=R',_ L_/_J~DF .ac r.; -; <br />NATIONAL POLLUTANT dSCHMGE CUMINATION SYSTEM /NPDESI <br />DISCNARGE MONITORING REPORT IOMRI <br />1-161 lI7-191 <br />~ ~ I <br />PERMIT NUMBER dSCNMGE MUMBEII <br />MONRORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM - ~ TO .~. {O <br />no-zrl ru-z3i lz4z5i !zs-nl rza-zsl r3o-3J1 <br />Form Approved. <br />OMB Noy2040-0004 <br />F J h D i' L A C ii G T 3 F'~~wel e><plree 05-3h X98 <br />F - ~ I'IAL <br />"ItiUl; - <br />NOTE: Reed'rnehucdaFU belor~ eelnp6tinp thie lorm. <br />PARAMETER !3 Grd OnNI QUANTITY OR LOADING !1 Grd Ontyl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br /> l16-531 !546// !39-151 !1653 !54611 ~ QF <br />l3z-37I EX <br />Muras TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e1-sa+ !64981 163701 <br />JlL NNU ,.nc SSE SAMPLE ~):: rF ( r~q' .::rCr :: <br />' ' ' .;:r~h'- <br />Y 13 U F L MEASUREMENT (;- /~ ~~ <br />D•IUcD ~ ./ U .~ PERMIT ~~ ~~CG{b¢ <br />~ R"c P~~~RL ES=1 PR4fFkrY >xt=;~S # ;r4 vr:n. :`ir{. <br />~ Y <br />K L <br />'f <br />P <br />15 J A <br />` REQUIREMENT . <br />, <br />, <br />y t r <br /> SAMPLE <br /> MEASUREMENT <br /> :::~:::~RERMIT.. ~.;:. .. ~~.. ~ ~ ~ - .. ~ ~.. ~. . ~.. - <br /> :REQUIREMENT. . ~~ ~ ~ .. ~ .. ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT .~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~~ <br /> .. <br />~ ~~~ <br />( <br /> REQUIREMENT ~ '> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT: "~:; : ~~ ~~ <br />~ ~ <br />~ ~ <br /> REQUIREMENT ~ .. ~ .: ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF L <br />AM FAMIUM WITH THE INFO AW TNAT I HAVE PERSONALLY E%AMIMED AND <br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> <br />~ MY INQUIRY OF TNOSE IN DINDUALS IMMEDIATELY RESPONABLE FOP <br />1 <br />`~/r <br />~ r~ /r ~ iJ ~; ~ /< OBTNNINO THE INF01U1ATION , I BELIEVE THE SUBMITTED INFORMATION 19 . <br />_ TRUE, ACCURATE AND COM <br />SIONIFICMT PENALTIES FOR PLETE. I AM AWARE THAT TNERE ME <br />SUBMITTING FALSE INFORMATION <br />INCLVOING I ~' /,~ <br /> TH <br />T <br />E , ~ ~ ~ <br />' <br /> <br />~ E POSSIBILI <br />Y OF RN <br />MD I <br />U <br />S <br />r <br />M <br />4 MPIIISONMENT. SEE to U.S.C. 1 td)1 MO 3a <br />bIONATURE OF PRINCIPAL EXECUTNE /.~ t, I r ) r -p / L // <br /> <br />ED OR PRINTED <br />TY . <br />.C. 1 ta <br />o. f <br />F rMr err mlvroA nrr :rcA.d~ FinrA w ro JIO,OQp <br />W <br />rle ormv:+.rn inprlmrwlWMnrrnFina+a•ArNerrial <br />OFFlCER Oq AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMM[N I5 AND GAPLANAl1UN VY ANT VIVLA I IVNS lMe/ellnCe Bn IRBCD/Denfs DI/Bl <br />,:.ILLtA.9L~: S~LID~ LI1I1 J.?k•L[::S Oh;,Y i'r C= 10-YBA ~r._q;+ Dp;.~ir :.Vn:~C 1. ~L~!"Ff. ?F I't.aL" [`~ 1?Pf;)vE!) <br />rf •.1CDF fS~ `. INJ?. L[•!IT;; RIf.L I+JS d~ r1P?LIF.) 'P7 4!.Pli?I=C ic,.L~nclS..a15 -:>F:E I.".1P, 9:: 5 4rln I.I'.litF D~ <br />EPA Fwal'3X2b~"10~~5F Prs6i8u'i ddn'bnd4Fiey Kd~d6ad. U ~ ~ ~~ L - • 'IREPlACES EPA FORM T.10 WHICH MAY NOT BE USED.1 PAGE OF <br />