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PERMI'IT@= NAMElADDRESS (ldr Fr:SryNr'/xrlw 1/D16awQ NATIONAL POLLUTANT DISCHARGE EIJMINATON eY6fEM //NPDESI FDrm Approved. ~~ N ~ 5 ~D,t <br />DI6CHARGE MONRORINO REPORT /OA1R) ~Q~O$ <br />NAME j L v:i:: ~', L Ff ~ • 1.161 /7-/s Ci1HONi C YET TES'PlQppove ~~'"65~1•SB <br />ADDRESS ,1 ;)(: 1.; :~!1 J17YSl)N CkG tsK MCY3S (SU pit YC) 2~4~ <br />Lu.J ~~ i'. .; ::i'1', I ~ RAJCJI IL D, PUB 7 PERMIT NUMBER aacHAAQENUMem F - FS AAL <br />I. r, ., ~, I;J IJ:1 L:' CD p1523 MONITORING PERIOD t1Z NOR ' <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION ~ . .. $v~ <br />,.L,I..,:mt.Lr: cD FROM 98 0/. O1 TD 9f3 09 30 ~` No DISr_LfAHGE <br />l <br />p <br />A <br />leUnp thb form. <br />NOTE: Rnd lnetructlom bo}or <br />'£d}h <br />.. 'i I'.+ : J L,•+ "' J'J ^::i 1761/1 l11-131 !14161 /16171 l18-19) 134311 <br />PARF <br />METER !3 6rd Onlrl QUANTRY OR LOADING !1 Grd Onhl QUANTRY OR CONCENTRATION NG FREQUENCY SAMPLE <br />. !d6.63 1646/ 38-16 N6.63 1646/ EX KY TYPE <br />l31-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rc:eal AN <br />g3 <br />!BI-681 l69. <br />7 <br />0) <br />h .::': ., .-. .ta Cl;'r: '/UAY SAMPLE ,.C.`>kx3 xG3:## ~ ~33,G#;' ~+O'v;II ( 23) O ~ ~ <br />I <br /> <br />_,L,; ,. ~.:. t ~~1 3 !'!I N I S <br />MEASUREMENT /~ 90 Iv <br />'-L <br /> <br />1,:r)~; ~1 ~ PERMIT :: ~OCS>%D . :.:;><91ii>a4eX <br /> <br />~~ #:Ri' <br />31:x'. ~:#,~~".'#M...; :. ~~i.#~#::. ER- Tf3L2':.' OdPDS <br /> REQUIREMENT ..~; ~ ~ ~"~ ~ <br /> SAMPLE <br /> MEASUREMENT , <br /> .::.PERMIT .: ~ ~~' <br /> <br />~ <br />~ ~ <br />~ ~ ~~~ <br />:.. <br />~ ~ ~ ~ ~~ <br /> REQUIREMENT .~ <br />~ <br />~~~ :., <br /> SAMPLE , <br /> MEASUREMENT <br /> PERMIT ... .. ... .... ...: .. <br />.. <br />: <br /> ftGQUIREMENT~ ::~ .. <br />~ ~ ~ ~ ~~' ~ ~ ~' <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT ..:.' <br />.; <br />... .. <br />... <br />:.: .. <br /> .REQUIREMENT •:~~ ' ~:. ~: ~ ~ ~~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT - <br /> <br />PERMIT <br />~ ~ ' ~' :. <br />'~ <br /> REOUIREMENT~ ~ ~ ~~ ~~~ : <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT ~ ~ '~ " ~ <br />:.. ~ ~ ~ ~ ~~' <br /> <br />.' <br />' <br /> REQUIREMENT :.: : <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT ..... <br />. ~.. ~ .. ... <br /> <br />REQUIREMENT ... <br />~ ..:..:... .:.. <br />. ~ <br />.::. .....::.. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF L <br />T <br />NFO AW THAT I HAVE PERSONALLY E%AMINED AND <br />TTED HERON <br />AND BASED ON <br />RM <br />BM TELEPHONE DATE <br /> ; <br />AM FAMIl1AR WITH <br />HE I <br />ATON SU <br />I <br />MY INQUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPONgeLE FOR / i <br />/ <br />~- <br /> <br /> <br />D <br />Z <br />~ <br />OBTAINING THE INFORMATION, I eEUEVE THE SUBMITTED INFORMATON IS <br />TRUE. ACCUMTE AMD COMRETE. I AM AWARE THAT THERE ME <br />ALTES FOR SUBM <br />TTING FAISE INFORMATON <br />INCLlAINO <br />T PE (y` <br />~ f// <br />/v` <br />J <br /> <br />M <br />_ <br /> <br />Q <br />8 <br /> <br />Z <br />. L ~ <br />\ YT~ <br />uC1 <br />) , <br />gGNIFICAN <br />N <br />I <br />THE POSgSIL1TY OF RNE AND IMRU90NMENT. SFE 13 U.S.C. ! 1001 AND a] 1LRE OF <br />ECITTNE <br />E y~ <br />, <br />1 I- <br />1 • - Z~~4/O~ f ~~ ~ <br /> U.S.C. F 1 ]1e. d1NWe„ u.sr e.,r mem,,n,Y hrAC, r,.r, y ro ! 10,000 gpNA <br />PRINCIPAL <br />X <br />TYPED OR VRINTED rwrn.,Ailwn bmnmlwlrWan..r,ammm, rldeFra/ OFFlCER OR AIJTHOR¢ED AOENf ~pDE NuMFIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !RelaencP d/ ettatAmenta hers/ <br />.-;:•. L.:,.:+ ;' ~%: 'I'L:5'P PLtOCe00kE. ltP'P R25ULP5 OF LETHALCTY DE RIVATIOYS AS "XP,FFY.CT", GIt0YTF1 G R°PRODUCPION <br />., .:i'r,:'!'L.)•~. i) "T'7%CCITT^. HPT L~YESP : EFFL AT YHC_k SPITTSTICALLY SIGNIF LJIFF L'L•:TYEY.U TF.S'P E CDNSHDL <br />C ~ ' <br />EPA Form 3320.1 18-95 Previoue•a none mey a uee ( ~ R AY O U - ~ ~ nn rl F n a r• I: o ~ _ ~ I ~ :~ G T O <br />