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PERMITTEE NAME/ADDRESSl1,..irii~eYryNrN/L«ura t/DlQ rvrJ <br />NAME LN~r.~Y i'j1CL5 Lt,4L r 1'iL.• <br />ADDRESS ~uujn( j.~i-y; (.j f.l: <br />LJ i ~• J.':i~.:. :.LVJ• r ~Ui TC mil. <br />FACILITY C?:c I~..Y ~ LI[~~ ~L'+Lr j-.Lr <br />LOCATIONf.L UY.. ,•i ~, l•. ~.1 :.~U <br />A 11,. JN,.~J Ts L..LI'L'ts Yr'~l., r~tKATjL. ?/5 <br />NATIONAL POLLUTMT d5CNM0E ELIMINATON eYSTM /NPOESI <br />DISCH~ROE MONITORING REPORT /DM9) <br />-y~ <br />PERMIT NUMBER DISCNMGE NUMBFA <br />MONITORING PERIOD <br />YEAR M0. DAY YEAR MO DAY <br />FROM / y ~ TO ~%'r j~, <br />126111 lI1-231 11+-151 /16171 11B-191 136311 <br /> <br />A• i <br />rL .,1L <br />., r• <br />Form Approved. ~, <br />pMB~Jo.~2040;00Q¢ '~ <br />Approval expi,iee O~I55 $1-98 <br />L.„4 ' <br />NOTE: Reed Irotruetlons before eompletinp thb form. <br />PARAMETER !3 Qrd Onlyl QUANTITY OR LOADING I<Grd only! QUANTITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> +653 - 154611 38-15 <653 15+-51 <br />!31•J71 EX MALY519 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-em !64681 /69-701 <br />'i SAMPLE Prv#.•f +!p;•##M :; !'•f {•~• <br />•~ <br /> MEASUREMENT ~ '~ „ <br />' ~ ~/ <br />fit: ~fl : <br />I r '. <br />C•,..~ 1 ., ~ .. AERML.T.':.:1: ..+k+k'i!:#~Ss: `. : .~Wili+Ci.d!~::ati' ~'a .,~;;•;:' <br />.:~ '.:: :i ?:::>EI#'F!1! <br />: <br />:: ~:r(~f :' :r ~, '~''i ERK~ <br />., r. -. c 'Y' A REQUIREMENT.. ~ ....... .. ..: l.w ;. . : <br />, <br />:'•.-. .;; .:. <br />oLL ;~~;r jL.TAL SAMPLE #+•#4{<# ti•b#'i#:< ####`<{• ~~ <br /> MEASUREMENT 1 >` rM ( <br />/u :.L i .. 1. 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G ;:~`. ~. ~f?ERNIIS~.:.:.. <br /> <br />.. ~: ~.:#~~p~~.#~~~~~: ~: <br />- <br /> <br />: `..~i~4b~:IN~'M # <br /> <br />.:.. .p.a ~~. `~~#:~4.:y:~:~pr~.:.. . 3.~.J .. <br />G ~ ::: <br /> <br />+ ~ r~df. <br />• <br />-rl L~L~.I ul,J~s VgLU REnU1.REMENJ <br />~ :.... ........ . <br />..;:.':;::. ~...:..•. -.:.. #t•~i ~~~:~~~ ~::~.:......~: ~~ ~aAa;_Y~aY74 ~, <br />_.L hl•a V,1. .4 JL SAMPLE• {/{.{.\•~}i. :'bpi.#'f 44{. i,.,:* if ~., .. yi.y <br />i b <br />'f' <br /> MEASUREMENT _a-a <br />r+~- <br />.~ ,~.,~ 1 C U ',?::~PERMII;';<:. :.~#iriK9'#.ir. ,.: :.~ {.,.#a+4;~:Ir # <br />~ 4.' .: ~.''x i(?C~?4TIfio. .~4f >:!:$~•f tf 15 ~ :;5.a:~::::: ~.":".. <br />_fr~Licl•T ur.JS~ '; .:LIJ_ REaUIREMENT: : ~'; :~. ~: ~~~ . ~~ ~~,~:: ~: M;, {• <br /> <br />~.: <br />-IBS..:: <~t:,4 X <br />• v / L <br />L <br />~cT:T: . <br />L.. ..r 1,. .a ,'.I:U1 L,1 SAMPLE. - „j M+}M44µ .}ti<n•µa4 titi<?4rN <br />-. .. Tom.. ,: (' -: r.f .'Lt. r+T MEASUREMENT .'i.!~/--' <br />_ n, <br />, ~ .v_~e~T-L~ <br /> :. PERMIT h~. ilT :.. '7t1?E3K <br />.: <br />~ i .+I!+~'M+F•it'7•.:5: <br />~' <br />~ <br />~' :...#rIR!SrAr+Ai?~L~;`:: ..'::':4»31Y9!~ K ': 4•, w., <br /> <br />..cr:uY <br /> <br />:rSTA l <br /> <br />- <br />I I LLt-..l ~:~.u:,5 IALI,i.. <br />REQUIREMENT <br />..... <br />' - ~ ~ - <br />~~74Ut A~Y:,. . . <br />~ ~' <br />~:~it:~IGY.. ~1X.~~. <br />.G[; <br />~~~ <br />" <br />~ .~:-~~:~.~.~~.~:':.::.~ <br />.. <br />..:....::: :::.:.:-.,.;.; <br />.: ~:': <br />..4Pi. <br />. <br />_.~ ,•~. ~. ~n.aJ.-. SAMPLE •,:.<{<p ~)y {. 5. {...;•p ,}{.{b4Y ...~ <br />_,; L MEASUREMENT ~ ~. <br />~ ul.. f J . <br />. -r . ~:, 1 ~. J :.. PERMIT. :;F #'.p46 <br />~ :#E: t'/- j'; T .Y - <br />, <br />) <br /> <br />VI )fF yt `M V' y~y <br /> <br />>9<1k r{"..:F -••;F <br /> <br />~.,!~eM.id al..n ., .A ,. y <br /> <br /> <br />C.R• 1 <br />~. ~ - <br /> <br /> <br />H.. <br />.'. <br />r. ~i,c:<f ur J~J v%.L.; •. ~REQULREMENT.' <br />~ .:. ... ~: i'` * 11 <br />11~ ~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERnFr UNDER PENAttr DF <br />AM FAMILIM WITH THE INFO uw THAT I NAVE PeaSONALLr ExAMINEO Mo <br />RMATON SUBMITTED HEREIN <br />MD BASED ON TELEPHONE DATE <br />` ~r <br />~ <br />. <br />~ y <br />.• <br />L <br />' <br />' ; <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOq <br />OBTAINING THE INFORMATION <br />I BDJEVE THE SUBMITTED INFORMATION IS ' <br />,. <br />i <br />, <br />• <br />„ r <br />/ <br />f: <br />1 , <br />TRUE <br />ACCUR/1TE MD COMPLETE <br />I AM AWME THAT THERE ME ~ <br /> <br />' , <br />. <br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING , r ~, <br />- <br />/ ' <br /> <br />~ <br />.. <br />- <br />; Y . <br />THE POSSIBILITY OF FINE MD IMPRISONMENT <br />SEE 1B U <br />S <br />C <br />S 1005 MD ]] ~ ! S <br />` / <br />i ~ ~ " ' - <br />. <br />' '~ ~' . <br />. <br />. <br />. SIGNATURE OF PIIINpPAL EXECI7TNE , .T <br />/ <br /> U.S.C. f 1]te, fAnrllNr unMr e,r~r menu mry Mc,Ydr !wa yo ro F 10,000 RE <br /> <br />TYPED OR PRINTED <br />ulYwmvirxni M,pl+avnMO/Mn.«n emmMauW 6Ywa! <br />OFFlCER OR AUTHORIZED AGENT A <br />A <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />1_,.,..,~„T..,f.,`,..jY~.r..'..~LI. i,i r11~`....,`..,h.'iv,•o.,~.,.,.`,,..,,.,IVTIL_..',L: ~•Li•_ i ~: - _ <br />.rL_ ~.: Ut•L:,M -i 1'n..._, -L.U ia•_. ~.\{.. ... -. .. T• •!r ;~• G. .,LL ..-_`JL ~ ... ,• •1.•.• <br />_ - . Y ~ _ i ~ <br />Y, I V I • 1 <br />EPA Form 3320.1 106-961 Previous editions may bs used. IR !ACES A F T4 RICH MAY NOT BE USED.) PAGE OF <br />