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PERMITTEE NAME/ADDRESS 8+ebdr fevWryNa.JGecanea UDI~r...p
<br />NAME !li;ti~ -.;JAL ::7"i'A`IS
<br />ADDRESS `+ A :. n ~". I 1• r
<br />FACILITY
<br />nT'I~.. ,c.,.., e. vArr: .')A_ f]1
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATON SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />1-761 17-191
<br />::O~ri50037 I,4
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ;I 1 U4 :; TO ., : Go ~ 0
<br />11a1f1 111-131 /14151 lI6-171 178-191 /36311
<br />Form Approved. '
<br />F' 0', p a / ? 'r(I ? -~ C: A QMB No 2040-OOQ4,
<br />(S r I } }, ~ y) Approval sxpiU ti 05-31-96
<br />'I '0;.
<br />NOTE: Reed Irutructiofu beforo completing this form.
<br />PARAMETER 13 Grd On/YI QUANTITY OR LOADING !4 Grd On1Y1 QUANTITY OR CONCENTRATION ND. FREOUENCV SAMPLE
<br /> 146-531 !5461/ 138-051 !46-53 15451/
<br />EX OF
<br />131-371
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />l61-esl ANN.res
<br />184851 TYPE
<br />169-701
<br />i1 SAMPLE ` % :::: ::: .`-:` G G :: ': - ( i i )
<br /> MEASUREMENT
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<br />I I; ,.. J i ~, _ y I w . ~. ~ r L ~. •; '^ MEASUREMENT
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<br /> 'REQUIREMENT
<br /> SAMPLE
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<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA Fr UNDER PENALTY OF
<br />MILIM WITH THE INFO UW THAT I NAVE PERSONN.LY ExAMINED MD
<br />RMATION SUBMITTED HEREIN; MD BASED OM
<br />- TELEPHONE DATE
<br />Ml]116On
<br />Rich6Td A Mr INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR I ~ '
<br />. OSTNNING THE INFDRMATION, I BELIEVE THE SUBMITTED INFORMATION IS, / I ~
<br />_ iice~,
<br />~SQe L1BBSdfint
<br />TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />INCLUDING
<br />SIGHIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />97~ 72
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<br />THE POSABILITY OF RNE MD IMPNSONMFNT. SEE 15 U.S.C. 1 1001 AND 3J I
<br />BIONATURE OF fmINCIPAL EXECUTNE x
<br />N
<br /> U.S.C. f 1 J1 e. IPWWWa uNrl Mar wturoa ,r,sY I•IC4Ma Fwa W ro S 10,000 AREA
<br />TYPED OR PRINTED aM armuvnun iw~iswnar,r o/hwar, emanrhaW 6 yara.l OFflCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANT VIOLA( IVNS (/ie/erenCe el/effeonmenls ne/9/
<br />SET.°LEAL.,~ SJLI~; l.1°Ii ~AIVFO FO9 I~-rn, jl-~;r; P3ECI^ E1^..: 5:, ..JE_T i7 ;'(iPrF., 'F r- rr c,• III: ~,-T'~t }..
<br />PAii: 7. ,. _. D, i. o. .;71+7il+YE~: ~kaA,-.E;±£tii i'LA.N i)UE I-1-)U.
<br />EPA Form 3320-1 106.951 Previous editions may be used. (REPLACES EPA FORM T<O WHICH MAY NOT BE USED.) ~ ~ . _ t PAGE OF
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