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PERMITTEE NAME/ADDRESSp+PL4 F.e1/1ryNw/Iocarlon l/DI>I,nmq <br />NAME A:'.i!., ~~A(. ~,l`iC'A'If <br />ADDRESS 1~1 %'• ~-' ` I ~/ f <br />S:: ?.--7 P.~)Ar ': PRI'1'.1 ~.~ FU1I I <br />FACILITY <br />LOCATIONii ,1 L ,, ,- ~ „~) d.;• U J I) <br />f <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM (NPDESI Form Approved. <br />DISCHARGE MONITORING REPORT (OMRI r ~r s r . OMB No. 2040-OQORp <br />l1-l el 17-191 ~' 1" J F/, }: L ~) o- a J 1 n .. ~ <br />~ ~ ~, r~ ~ ~~ ~ -,/ A r Approval e~piree OS-31-96 <br />V PERMIT NUMBER DISCHMGE NUMBER t~ _ ~ ; ', S L <br />MONITORING PERIOD ~ j ' , <br />YEAR MO DAY YEAR MO DAY <br />FROM J.L 'Ji .)1 TO Vl V<r 3U :=::: };' ;;I ^rlJ.""-'',P ) Z_~ `::. .. <br />110-7 )/ l17-131 l1b751 116-771 118-191 136311 NOTE: Raad InatrucElona baiora complatinp ~Ehia lorm. <br />PARAMETER !3 Grd Onlyl QUANTTY OR LOADING /o r}rd Onlyl QUANTITY OR CONCENTRATION ND. FREOUENCV SAMPLE <br /> 106531 /50-611 139-45/ /4653 150.6// DF <br />131-371 EX <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS s7-e3~ (64691 /G9-701 <br />., :1 SAMPLE .. :::t :~ ~: ~ t ::.;: ] ... .. ( 1 ' 1 <br /> MEASUREMENT <br />i04.1.r i i.• '.! PERMIT :ny1.;.4F rr;:nG^ L'~ -'+:~" .5 .riar:•'.: .r `l.i'. <br />~P[.Y '"";"', <br />.... ,. <br />'~F'r'LI~L:.: ~i J'~'3 Y'Ai.'Jr REQUIREMENT :`r::?;e 9*[r~r,U.t ~ "A'!."'lfl~'. <br />~JL:. 1L::A%L_ SAMPLE `G. :S: _ .. <br /> MEASUREMENT <br /> <br />1;Iy~5 i ! U .PERAAIT~~ rp~F Gr jvO ~%O ^ta x'91 r, OOG PCOO.:: . >.:: ~~::: Oi5 I N;'E~ YA o. <br />_F'r'L~: .i .'J'>5 YALJp; REQUIREMENT. ;;; :k,•r,• <br />DAIi.Y Y. <br />':.i'. <br />:4'7!~7"t <br />)TL n4:/ .ah`A7_° SAMPLE `3:-G". .:~•:.. rff~, ... .. ( ,'.11 <br /> MEASUREMENT <br />3 S ~ ~ 1 .{ ., PERMIT :::7 :a Sr D t :_ ?' :f ''' :: :~ ::: ~]{: t ::: a: p :::: <br />:F~FLLr.1: .,~~';~ JF 1.'J c. REQUIREMENT •t ~I.i LY "~' ~%:. ;; :31:T <br />J r•F I:r _'~q i. .1~ "J i'. SAMPLE ( ~.~) ...:: ep <br />H @ C T }(': n . " ~ t. I' i ` r :, : r MEASUREMENT <br />~4D'->U ~ ;. ~l PERMI7 )I~:T,>;iAL ~i~. t'J~': rw.~:-::: ... ... ~ K.C:c~ .t-;f/, .,, <br />.PFL'•iEii7 .,f i-5 VA;.7c REQUIREMENT .Sar.A .A P,; ~. p,i LY t~ "~'. ~.DS :'.1 <br />)IL ANU .: st A.':i SAMPLE ~~:az~:; (:J EI ~a44:?; .. <br />I S U A L MEASUREMENT <br />;4U66 1 L J PERMIT G944r REBJR: Y ES=I 7C f;k -k C: .;:O:a .. Ss L:"ia {r l:: :: r: :::. ~ N!'F./ Ie7Ai. <br />:F'F'LUENT ::NJ.; VAL'J"_' .REQU.IREAAENT I:~ST !!Ax NO=~ r::::;-:, .-. <br />MO'.,n <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> 'REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I DERTIFY UNDE11 PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />HSChard A• M1~1Ei071 MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR J . <br /> OBTAINING THE IHFOIIMATION, 1 BEUEVf THE SUBMITTED INFORMATION IS <br />l <br /> <br />~ IQs President TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT TXERE ME <br />SIGNIFIDANT PENALtIES FOR SUBMITTING FALSE INFORMATION <br />INDLUDING <br />' ~ <br />`r°'~~T'V~ (~r.r~ rT.2}1.3 <br />Y/V <br />Y O~ OrT On <br /> , <br />THE POSSIBILITY OF RNE ANO IMPNSOMMFNT. SEE TB U.S.C. S 1001 AND 33 <br />U <br />S <br />C <br />1 131 p <br />m <br />S IO <br />IA <br />l <br />4 <br />4 <br />6 <br />DOO <br />4 <br />610NATURE OF PRINCIPAL EXECUTNE ! / J <br /> . <br />. <br />. <br />. <br />, <br />w <br />e <br />. I/ItMr eNM <br />brla raY <br />.M <br />ws Ip b <br />K <br />TYPED OR PRINTED mewmvinnr imPdsmwnrWMlwwlemonex AM6YAArA! OFFICER OR AUTMORRED AGENT CODE NUMBER YEAR MO DAY <br />GOMMtN I S AN V cnr~wnn I wn arr wn r Yw~w I Iona Ineormce an suecnmams norer <br />45ET:LF:A?i.' 'ELI i5 LIB;" :47VED F]P. 1~-Y:iY 1:3-;!R PFIr~I^ rVrh: ;;L:.Jc~T :- =C .~~^ .' 4 <br />~AhP I.~•i.I~F P, ti. S":/R'S»kItii t:AI~kS."c::T ?LAti GUS I-1-)a. <br />Fam <br />eDltlone may De uea0. <br />EPA <br /> <br />;1i,,~5~- _1. <br />t <br />