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PERMITTEE NAMEIADDRESS arNLb FrdiryN~dL«anm UDIO wv) - <br />NAME cLt.ti.,Y I t-~..L~ Li~..Lf i,•~.. <br />ADDRESS ~',, ;,T,lr i.~.: ^'I::~ <br />14: ~. L, viLi+ '.:L1L,. f ~UITL 41i 1: <br />FACILITY LLLni~Y 1-IiL L?. _`,i.. L.f 11.1.• <br />LOCATIONLL `..«1.6c (.V uCiC 2C <br />A'TIt~ U.,.~u~ T. ;,u~+'L.. Yf'-uNEnA11GN5 <br />PARAMETER ~ l36rd Onlyl QUgNT <br />137-371 /16531 <br />AVERAGE <br />JIL F+t:i t,h'_A5t SAMPLE k+iM44YA <br />i ~ ~ A L MEASUREMENT <br />J 4~ G b 1 i- U ::?<P,ERM,T.::i"~ :':.~:~90!~'~31!~'~!.r. ~. ;:~ ;'.~;'. <br />~htLU~i~.l 1,n',J55 'YaLJE REQUIF~MEN~7 g~.: '~, <br />NATIONAL POLLUTANT DIBCHAROE EUMINATON eVHfFM /INP~ESf <br />DISCH~N6E MONITORING REPORT (DM91 <br />'4- <br />PERMIT NUMBER DISCH7JIOE NUMBER <br />FROM <br />MAXIMUM <br /> <br />i.~J TO y'J <br />'I 117-731 171-751 116771 <br />7N0 ll 6rd OnlYl Oi <br />- l3B-I61 <br />UNITS MINIMUM <br />y~ y~>k>a~ <br />U ~,: <br />::.:~.:~ <br />J~".:7~.<: a::::. <br />.. .. ~~. °. ~~~... .. ~~fl.::i.fi~..., .. .. ....5 <br /> <br /> <br /> , <br /> _ <br />Form Approved. ~ - ' <br />N ; <br />:lr'J <br />~~Nifft :+TK T,DM@~Io.L2040-01044 <br />' <br />. <br />. ~1-98 <br />Approv4T'ezpg9e OS- <br />~Uu <br />n .ic i~~`• ~ <br />L <br />f ~ 1 L~YMI <br />tS [!v L.K <br /> ~ <br />NOTE: Reed Instructlorr bs~on eomplstlnp <br />thls form. <br />VCENTRAT10 <br />N ND, FREO <br />UENCY SAMPLE <br />5 <br />66/ EX O <br /> ANALVBIS TYPE <br /> MAXIMUM UNITS nasal Ins-•ral lAa>'nl <br />l~1F444r. . <br />.~..:'r...~.::~: <br />r`~ <br />y. r5},,:~~ s <br />'! _ .'5.39 ~ .:. <br /> <br />7 I ~ /./1!~.is /,-Ylv <br />Yll~-' "^ fir" <br />- MY INOUIIIV OF TNOSE INOIVIDUKe IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19 <br />TRUE. ACCUMTE AND COMRETE: I MI AWME THAT THERE ARE <br />SIGNIRCANT PENALTE9 FOR SUBMITTIHO FALSE INFORMATION <br />INCLUDING / <br /> <br />- I <br />~ "~'~ ._ <br />~ { <br /> <br />L l/ i <br />~(~ <br /> <br /> <br />' <br />1 <br />_ 1~1 j1 ~ E_v(T <br />'~''~ ~ , <br />THE POSSIBILITY OF FINE AND IMPRIeONMENT. SEE le U.e.C. E 1001 AND 93 <br />F ,/ <br />- gIONATURE OF RIIMCIPAL EXECUTNE <br />~/~ ~" T ~ <br />~~ <br />~. 3 <br />~I <br /> <br />TYPED O.°. PR;NTED U.B.C.f 131e. IPr1WIM. u1dw•dw~N1v11r. INy iKAd. fYNIWro <br />I0,000 <br />--'^~^--4.-_^M.,.!.-..!+!n!PI!!+r..»~s,r~rA•.ndb wva/ <br />OFFICER OR AUTHORIZED AOEM <br />rnnF NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rs/srsnce s!l sttechmsnra here! <br />I~. a .„I .L In„!'. Li.`:IT;I oIL~ c,: n,ilJ~l,f La r., ~LTTL_a;•L.L ~~L,l ..s I_I,tli kF,'L.I.u _ i ,Y-.r_. ~..ir _.crli- <br />~c.. ,.I_.._ -~ uF Nr.U.;r -.cUU1nLr'.tl~T~ L.ri.Jtl< I.a,~, ?. b. uIL I. .Ir.~dSt - ~c~ .. .~. <br />. 1... r..l v .~ r r - _ - 1 I <br />~ <br />A FO T<0 MICH MAY NOT BE USED.) <br />Epp Form 3320.1 108-961 Previous editions mey be used. IR PLACER <br />PAGE <br />OF <br /> J v 1, 1 : / ; ... - . - <br />AVERAGE <br />EA V4M'3M `~ <br /> <br />