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<br />PERMfTTEE NAME/ADDRESS gMi6ferWryA'~/lor.nA, dPIEG.ru/ <br />NAME ~..'.,.•~ -J 1:, Cl)';P~~,Y <br />ADDRESS u i h . ,. .. v <br />iAYi/~. !. ~J .li /~7 <br />FACILITY <br />LOCATION ,.. A .1 ! r .. !~ <br />. a: <br />~') tL:r )l <br />S nl. .n, .I <br />NATIONAL POLLUTMT DISCNMOE ELIMINATON SY9TEM (NPOES) <br />DISCHARGE MONITORING REPORT /DMR) <br />Z-161 /17-191 <br />.. ,~.. 1 . •) ~'• 1 <br />i PERMIT NUMBER DISCHMGE NUMBER <br />MON170RING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM i L J TO ~'• L.' <br />/Jll Jla nvom /nLJCr tlA.J)r /JAJAI /R/F9f1 <br />Fonn ApprovdeOd, QQ m-, <br />(~ i, ~` 4 1i1) ` .~ .). ' 1 ^• E.pBovel.expl~ 8 05 31-98' <br />_ ti1L 1 a <br />..t T <br />~ " ~__~ <br />N01'E: Rsed Inetnletlwle before eompletlnp tbie form. <br /> <br />~~ <br />PARAMETER l3 4rd On/yl QUANTITY OR LOA !~ Grd Onlrl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br />l3Z-371 146531 /5s-611 13f1d51 /46531 15L611 EX DF TYPE <br /> AVERAGE MAXIMUM ITS MINIMUM AVERAGE MAXIMUM UNITS <br />l6z~ss1 MN.VSIS <br />(µ6g1 <br />169-701 <br /> SAMPLE <br />MEASUREMENT , ~~ <br />~ I ~ <br />~ ~ ~ CL[' -.~ <br />~ (~ / <br />~ ~ ~/-: <br />( <br />) . <br />~ <br />i~ ~ <br /> (j ~ ~ , <br />^ <br />.J ~r ... _ I. !) PERMIT ~<:r'. C-; ;. .-~v fi ._,.. <br />6. y ... <br />' .- ... ~,t ~ <br />'!';'; f -3 ._ <br />.~ET". <br />v . .. n I, REQUIREMENT .. .:::I.. . <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~. <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENKTY OF L <br />MILIM YNTN THE INFO AW THAT 1 NAVE PERSO <br />RMATON SUBMITTED H NALLY EkAMINFD MD <br />EREIN; MD BASED ON ~ ~ <br />Y <br />~' ` TELEPHONE DATE <br /> ~ <br />' ~ <br /> MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR ~ . <br />( ~ ~ <br />~ <br /> OBTNNING THE INFORMATION, 1 BEVEVE THE SUBMITTED INFORMATON IS <br />TR ! <br />~ ~ • <br />~ <br />A <br />% <br />~ <br />~ <br />I <br /> UE, ACCURATE MD COMPLETE. 1 AM AWME THAT THERE ME <br />SIGNIFICMT PENALTIES FOq SUBMITTNO FALSE INFORMATION <br />INCIUDINO . ~ <br />_c.. _ <br />.~., <br />, <br />y-z~ <br />~~ <br />~+ ~" <br /> <br />7 ) I <br /> , <br />THE POSSIBILITY OF NNE MD IMPNSONMENT. SEE 1e U.S.C. f 1001 AND ]] <br />gIONATURE OF ~IINCIPAL EXECUTNE ~ I l <br /> <br />TYPED OR PRINTED u.s.t. 1 tste. (hnnrobA uWr dr. m1mA nrr AxAdA sire w ro d 10,000 <br />And wmvirAAn ArwlAaln~+t o/M1wAAn smendM Arid 6 wral <br />OFFlCER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />wmmtN I a ANU eArL.ANA nurv uH AIrT vwL.n I vulva rrrererence en errecnmeno nerel <br />. .. .,L :i'. ~:. ..: 'i' A'..r i~:T ;"v:.. L. ~1L.... ..1: :i ,....; ~. F'l'-. ~=:1;'l ~'r ~1~. '~ ^'.. ,: i! 7:.:.T: 'i_ , <br />._,.:'1 ...:5 ,.. .. .17L.., .,i'S: ,ASI'; ~. r'.. .: >t~yi•.:r _.. rl~ Pa: ~!.. ::i~'i" ,'f1.1 ',.=r T'~~ .. ~~ ~•r' :'..:U' Ii' ...,. ?. ,)L:. <br />1 1(1- T'1 .• f.rr~r•,rHr:-•.^o to-~-o <br />EPA Fwm 3320-1 108.86) Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 p U9 n 5 / 9 •? :? I 1 4- 0 9 2 3 PAGE ~ OF <br />