Laserfiche WebLink
PERMRTEE NAME/ADDRESS (Gr1,6 FrdlyNrWlscnlm IJalai..rp <br />NAME _ ., , -. I. , J ~ ., .: p !! P A:: Y <br />ADDRESS •., - '• ,. ,. !. J <br />Iin~sU,.r, ~:; Iir.;l <br />FACaIn <br />LOCATION a ~ Y „ ~.. - 1 ! ~ , <br />NATIONAL POLLUTMTDISOHMOE ELIMINATION SYSTEM /NPDESI <br />DISCHARGE MONITORING REPORT /OMRI <br />1-161 17-191 <br />CUUJUl.::i. 004 A <br />PERMIT NUMBER DISOHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM y 7 11 J ~'FO <br />/20.711 /JJdil n~ec. ' /Jr.7 JI OAJAI /.RYl9fl <br />Farm Approved. ~ <br />~. 1 • ~ ~ I .. r:: - , .. , ; 9MB Ko{ 204(1-0004 <br />~ . ,/ ~ ~ Approve! sxRir~e OS-31-98 ~, <br />:. I <br />- - FIV~r. r <br />'0.4;. ~ _~ . <br />NOTE: Reed Inetructlom before eompletlnp thb form. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING 'rd OnlYl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br />131.371 !4653 l5a61 /38<51 !46-53 50-61 EX OF <br />TYPE <br /> AVERAGE MAXIMUM UNIT MINIMUM AVERAGE MAXIMUM UNITS le7-sal MALYSIS <br />/60.66) I6S701 <br />Ji., ? ,.. - ,.:ASC SAMPLE .. ,~ ~C:YS-'.= ~ ~ ~ ~ .. I <br />I <br /> <br />v . -~ .; .i .. <br />MEASUREMENT <br />~ <br />V I <br />Z <br />I JG <br />~' •! `) <br />-. .. ~.. '. J .PERMIT ~~ i-•` r'~:;:.~ ~ r Et'1Jft'~~ ~ ~ <br />~ <br />~ LS:>= i s='t %A?F.,~') ~ .-::: ~...~~-.4 ~;._..:.:~..~~. ~- ~ • f ~C1 C..:~ ; ~:: j~If ll:.j: <br />.. ~ .. ..' ~~ _ -. i. ;~ i <br /> <br />. :REQUIREMENT. .. ~ .. <br />..~ <br />1~5E: N.3L : <br /> <br />MO=U <br />::.:::. . <br /> <br /> <br />.... <br /> <br />:3R T:S. . <br /> SAMPLE <br /> MEASUREMENT ' <br /> .:.:PERMIT..~~ ~ ...:.. <br /> <br />~ .:~~ .. .. <br />:.... .. <br />~ ,, <br /> <br />~ ~ <br />~ <br />- ..: .. .. <br /> <br />~~~ ~~ <br /> ~REOUIREMENT ~ ~ <br />~ ~ ~ <br />i <br /> SAMPLE <br /> 1 <br /> MEASUREMENT <br /> PERMIT ~ ~~ <br />,. <br /> <br />~ <br /> REQUIREMENT. ~ ~ ... ~ '. .. .: ~ . . <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ .PERMIT <br />:. .. <br /> .REQUIREMENT ~ ~ ~ ~ ~ ~ ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~. PERMIT. ~~ ~~~ ~ ~~ ~~ <br />.. . <br />~ <br /> REQUIREMENT :. ~ :... ... ... ~ . <br />.. . <br />... . <br /> SAMPLE <br /> MEASUREMENT <br /> ~~. PERMIT ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~:.. PERMIT ~ <br />~ ~ <br />~ ~ ~ <br />~ ~ ~ ~~ <br /> REQUIREMENT' ~. ~ <br />~ .... ~ ~ ~ . <br /> ~ <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF LAW TNAT I NAVE PERSO NALLY ExAMIN ED MD TELEPHONE <br /> <br />AM FA <br />MIUM WITH THE INFORMATION SUBMITTED H <br />EREIN <br />MD BA <br />SED <br />N ~ <br /> <br />{ DATE <br /> ; O \ <br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIB <br />OBTAINING 1HE INFORMATION, I BELIEVE THE SUBMITTm INFORMA LE FOR <br />TION IB i L, <br />l\ <br />~ <br />1 <br /> TRVE, ACQUMTE MD COMRETE. I AM AWME TNAT TNE <br />SIONIROANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INC RE ME <br />LUDING ' c~ <br />i_~/~yM~,. ~.l~r- - <br />~~ ~-1 <br />~ I, <br />[)" <br /> , <br />THE POSSIBILITY OF RNE MD IMPNSONMENT <br />SEE 1B U <br />! 100 <br />S <br />C / ~ ~ <br /> . <br />. <br />. <br />. <br />1 MO ]7 <br />SIGNATURE OF PRINCIPAL E ~ ` 1 <br /> U.S.O. f t]Le. lAtleOMA uldu dwr mnn.. rrAY hcprW Aw. W ro J 10,000 XEt:lfilVE AREA <br />TYPED OR PRINTED .nd er nv,rinun Mrp•IrrnwAe/Mfwrn emanM.rM6y.val OFFICER OR Al1TN012ED AOENi CODE NUMBER YEAR MO DAY <br />.,vmmo. I a nnv cnrcnnn r ran yr nn r vwcn r Ivrva Inrsrence sn snscnmenrs ners/ r <br />i__ ..:... +[:._. ~ u^.Iti :.:.li .:i.c4.,:..~ ~:LL:. ..i _ n=''!_ •' ''",a c=1'lYHE'.`1d 'Crp 17rI+'ij ?i5 . <br />,...,6n b.. ,. ,.'I. !. '7~ L:`i.' .. .Li 4:. ,- ~ ?1::Y' ~'~:'~ it.CL: :.7 `1" '.I) 1 !'" lc,~ !. .. I•r'...: <br />d:, :d-. .: I. r..;.t.i;. •~ =1v1T1/i ,r, r.',.I.v. <br />EPA Form ]320-1 108-96) Prevlow edmons~mey be used. ' (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.) ~ r~ ~~ ~ ~ r_~ !~ 0 71+1- 0 `) 2 3 PAGE i OF <br />