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PERMITTEE NAME/ADDRESS (lndrb irWry Nrd7ocmlm dD1Q.nnq <br />NAME d "J ~ I .'. . . <br />ADDRESS tj U d I t 'i ~. 2 " j ti <br />Y.:)• r: 111 ).t~ _ <br />pA")alv. ~J Tl~lj <br />FACILITY <br />Odle Rt.°•~)4~°3, LI"ITcu <br />LOCATION <br />°PNE 11.: T 6T '-~: a:, v n /-vt a:.e Tac <br />NATIONAL PoLLUTMT DISCHMOE ELIMINATON SYSTEM /NPDE$l <br />DISCHARGE MONITORING REP011T (OMRI <br />I1-161 I17-191 <br />_ PERMIT NUMBER DISCNMGE N MBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM a ~~ TO <br />1747// I??-131 111-151 I16-771 178-791 !363!1 <br />Form Approved. <br />Ofv1RR8 No: 2040-0004 <br />PO}~6 L ~aCfl; T:1 "Approvelb~piretiO~=~-lee <br />(SI)~1I ~~1 i.TT~1~: <br />'' - FINAL <br />'1I..')n r( ' <br />~~NOTE: ~ Reedtirlte'tr`uctloni 6{la~ eem~btinq this lam. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NO FREDUENCY SAMPLE <br /> !4653 154611 /36-151 146-53 /546/1 E OF <br />I31-37I X <br />Muvms TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sS-ea/ 164681 /63701 <br />L.iL ApU GIiFA :r: SAMPLE <br />MEASUREMENT u0-.; Z,t <br />~ j ( 9U) rfy{L,-::y ;<i:rt :}C: .., ~ <br />V I~ ~ 9 L .~ ~~ <br />~~~Uhb 1 U J PERMIT ~ ,-tGdi:~>!QS .. RFPORY E5=1 R}xsl.l's .::::::..i :'>~v4;: <br />;' ~ <br />~ ~~ {' _ <br />~~ <br />`i R G Y <br />F <br />a' I U A I <br /> REQUIREMENT ~ .. <br />~ , , - <br /> SAMPLE <br /> MEASUREMENT <br /> .:.:..:PERMIT ~~ . ; ~ ~ ~. ~ .. ~ :. ~ :: . . <br /> .fEQUltiEIiAENT <br />~,~~`~ ~ ~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT ~ ~. <br /> PERMIT ~ . <br /> ~REQUIREMENY~ <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 />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERnFY UNDER PENALTY of uW THAT I HAVE PERSONALLY El(AMINED MD TELEPHONE DATE <br /> AM FAMIIIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON <br /> <br />C '~ I ih ~ ~J[ i I ~/ ~ <br />1: ~~ MY INQUIRY DF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTEp INFORMATION Is <br />% / <br />- <br />, <br />_ <br />TRUE, ACCUMTE MD COMPLFTF. I AM AWME THAT THERE ME <br />SIONIRCMT PENALTIES fOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~/ r / ' /I i ~ <br />' <br />! , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT <br />SEE 18 U <br />S <br />C <br />f 1001 MD as 1 ~. <br />C / ~- <br />r <br />/, ,~/ t . <br />. <br />. <br />. BIONATURE OF PRINCIPAL EXECUTNE )7 r - ' ~ <br />' ~- ~ <br /> <br />TYPED OR PRINTED U.S.C. E late. fRrn•IW. udr e4rr Wvn. nwY NtI.O. r.». w ro s IO,OOp <br />Andnnr..Nxm hyvirm.nr olMtwwr i:nNrrM rN6Pral <br />OFFICER OR AUTHOPo7ED AOENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS ANO EAYLANAItuN ut• ANT YwLA nuns frorwann a/i Bnecnmenrs novel <br />-i~f'TLeAdLF, i7LID: LI{I'f' APr'..I`:5 UNi.Y IF C= 17-Yi!, :II-Hr; YI•c.:lY :.Yzt.i i5 /'LAT:S°.L. I~ CLF.I" S~ A^PNL)V~:C <br />~r d]CD, T3~ If!~`: Li",LTS :ILL !ICI d~: APNLS::J TO P?'P~'i*.D ,1LA.,Jnu.~u'::~ -~Er I.~.lA, P'S 7 ::Rq I.~.tD, P;, <br />EPA Fa 20- I Pre ' pions ey '~ - -IR !ACES EPA FORM T40 WHICH MAV NOT BE USED.1 PAGE Of <br />.)g !' / ,7J 111-! ~';" <br />