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PERMITTEE NAME/ADDRESS (LcW6 FxWryNs./faeaua yoyL..,,p <br />NAME .. :.: p. '.,_i~. ,~.'.vl. ~';r':i:::,C <br />ADDRESS U :. i n ~ , ti <br />FACam <br />LOCATION 15rt5 ~'.'. _ i y} I r <br />..... 'r ... ~ -.A ~1~~r+ <br />NATIONK POLLUTANT D19CNMOE FLIMINATION 9YBTEM NPOES) Form Approved. ` <br />DISCHARGE MONROpING REPORTPORT D~ ,, (~; r ~, c. MB~ 2 0004 <br />1-161 17-191 .'~Ip'. ~. s (' . !'~°d Q~-,. <br />.. pprovel expitee 05=31-98 ~ <br />PERMIT NUMBER :' DISCHMDE NUMBER _ "r' i ti 1 f, ~ <br />MONITORING PERIOD ` ~• lu <br />YEAR MO DAY YEAR MO DAY <br />FROM Y ~ TO `I'; 1. Ji ~~~~ ~'i GL SCHd.:I ~: •: ~_ ~ ==i-:' <br />lsa~n nzav ro.-.~, r.~oTl r.w-gym rar,_.a11 ;NOTE: Rnd Irutructloru be}on cempleElnp Thb fam. <br />PARAMETER 13 Grd OnlFl QUANTITY OR LOADING 11'Gid Onlvl QUANTITY OR CONCENTRATION NO. FREOUENGY SAMPLE <br /> <br />l3Z-371 15.63 151-61 ~ r 198-15 It669 151.61 EX TYPE <br /> AVERAGE MAXIMUM UNITS ~ ~ MINIMUM AVERAGE MAXIMUM UNITS /s~-e31 ANA<Y9B <br />!64581 169.701 <br />` ~ .. ,. , ~ ..... .. SAMPLE <br />MEASUREMENT ~ . .. ~ ,- .f <br />~ C~ I ` ~' ' C J ~ <br />/ <br /> <br />-, ., , <br />. 3 <br />~ <br />~„~ <br />~~„'., ~.: .~ :PERMIT. ~ -.~:7C~F;k ~t0:; 3:C~:,~ ~ ~.... *'-: : 7i:.. ~ ~ ~.: ,~.L`.~` =..~~.~.~:... <br />i ; REQUIREMENT <br />~ <br />~ <br />~ <br />~ <br />. <br />~•,L. ~: :, .~. ~ ... .. SAMPLE .. v - ~'.`hx: ~ ~ .~ • <br />I <br />I <br />1 I <br /># i <br />'~ <br />% <br />. ~i i <br />~ <br />V <br />' <br />. <br /> MEASUREMENT ..' <br />I ( <br />- t ~ t) ,~.. <br />1p <br />..u I.., ~ 7 PERMIT <br />-,. <br />... ,.. .~ <br /> <br />~ :#O ;v': .~',»," .~'•': 3'G'it ~T YF~E/ •. 1.~Ki; <br />' ....: r:. ;' ~ : ;r ,.:; • .REQUIREMENT ~ .. ~. ,•t.A T . xX <br />, ~:~#I s•i <br />- <br />~ SAMPLE <br />M - - <br />.. - ~ <br />_ ~ <br />J~' ~ <br />L <br />- _~ <br />(~ <br />~ <br />~ . ~~ ~ <br />U <br />'l t <br />. ,i i ,_ _ , i .. EASUREMENT ` . <br />i J (~ 7+~. j <br />ud ~ 1. :~ .. PERMIT . . .. ~ - i' + . «".:4::2 Y< '}..0 '?~"~'i~" . ~~il/ 'riA? <br />:... :.;.~ i., x .. REQUIREMENT .~ _. ~ JQpA !.V,: E'..i;'( M.L' "'r:/[, .. ?1.UI'21} <br />.. ~ i' 1 .~ :. SAMPLE <br />MEASUREMENT ~ ~ .. ... .. . -.. i •, i JI <br />~ /Fit <br />i4 <br />/~ <br />.. i ) PERMIT . ,. ., i:K::. .. ~ -.- ~ -,. <br />-^°#=`~ <br />Zti <br />CAF "'id <br />~ ,: if <br />. .. :li7o.i +r•i. !:: REQUIREMENT SN <br />i 3 <br />i /! '': <br />~ <br /> . S <br />9 <br />SI • <br />~ <br />T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I cERTI <br />AM FA Fr uNOER PENN.Tr of uw rNAr I NAVE PER90NALLY E%AMIN <br />MIl1M WITH THE INFORMATION SUBMITTED NERDN <br />AND BA ED MD <br />9FD ON <br />/ TELEPHONE DATE <br /> ; <br />MY INQUIRY OF TN09E INDIVIDUALS IMMEDIATELY RE9PON918 <br />OBTNMINO THE INFORMATION, I BDJEVE THE BUBMITTED INFORMA <br />LE FOR <br />TION 19 \ <br />~ <br />~ <br />I , ~'~ <br /> TRUE. ACCUMTE AND COMPLETE. I AM AWME THAT TNE <br />SIONINCANT PENALTIES F011 SUBMITTING FALSE INFORMATION <br />INC RE ME <br />LWINO ~' ,!'.\z .~~ "y_ _yl _.-. ~ ~ <br />"'I <br />~' <br />' <br /> , <br />THE P0591BIL1TY OF RNE AND IMPNBONMENT. SEE 18 U.S.C. 1 1001 AND 3J <br />BIONATUIIE OF P111N A <br />E <br />E I , <br />'' <br /> u.s.c. F 19te. lMrroa u,sr ewr mAma w.r NtAdr wnrr w ro IIO,IX10 L <br />IE <br />CUTIVE <br />TYPED OR PRINTED .n1 wmr.irwn inMe++~+r erMtwr.n a monT. rW s va.ra/ OFFlCER OR AUTH RRED AGENT coDE NUMBER YEAR MO DAY <br />,.vmmon 1a nnu onr~nnw I Ian yr nn r vlv~n I Iona Inherence en srrecnmanrs nary <br />.. .. '_ __ ,... a. -, d'., 'S ,.L~ PL. ,., .., .- .. ;..': FOit <=i'.'V.r~1. .., ... ::-,~,~. TS`. , <br />_ ~.~.~ ...,... .i:..... „_r .. +-,.Y,.., .. >iJYr:'r.'.4.Y't P:,:?i•:l .. ~n~;gr`.. ~... - 'i~ ,",:L' iF.~L.A.[. Jl.. - <br />EPA Form 3320-1 (OB-85) Prsvloue editions may be used. , (REPLACES EPA FORM T40 WNICN MAY NOT BE USED.1 ;J CO 2 3I `7'r !i'1 : 4-'J 9 3 PAGE ~ OF <br />