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PERMITTEE NAMEIADORE55 Qlldli fsslyNa/!xulal l/D1~6rrer) <br />NAME ?:.. -~. _?. l '; i. ~,?'11`4: l <br />ADDRESS ~,.G e,,; <br />FACam <br />LOCATION y n Y ~ ...:~ ~. ~ l} <br />NATIONAL POLLVfMT DISCNMOE ELIMINATON SYSTEM /NPDESI <br />DISCHARGE MONITORING REPORT /DMRI <br />11-161 17-ISl <br />. lui: ~ L' <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM y 7 , ,. ~. TO ' `/ i <br />/]/LJ/1 /JJJ 21 /JLJSI /J2JJ1 OAJOI /.M311 <br />Forth Approved. <br />-. , k . : '~ ,. ,, ~ l ~ OMB.No. 2040004 <br />~Approvel alrpiree OS-31-98~ <br />/; .r .,~ Je~ ~.. I~l , <br />- t~r~a. <br />!i r:' <br />NOTE: Reed Inetruetlorr before completlny thb 1wm. <br />PARAMETER l3 Grd Onlyl QUANTITY OR LO E;ING Id Card Onlyl QUANTITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br />I3Z-371 146-531 /5a-67I 13B-I5 !4663 15661/ EX DF 7VPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />l63-691 MALYSIS <br />/66661 <br />I6S70/ <br />...L'~J _,: •. .:( 't ': ,._ .; :~1 SAMPLE .. : ~.. .. .. <br />t _ ,~ <br />,- -, ,, MEASUREMENT ~A:~ . <br /> J' <br />... ~ <br />` PERMIT v;x ~~~x#~ ~ 'v~:~.a.xS:;< .. iL~~tl <br />~ ~. .~ ~ :rl~ ~~ ~ :~?# .k-~s : . - : .T ;<:..~: <br />n i ;. <br />~~: w: ~. ~..: <br />. 1'' . L J REQUIREMENT RN.~'~~~LD~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br />REQUIREMENT ;,5 / <br />V~ <br />~ <br />~ <br />~ <br />~^ ' ~~~':.3::a;..a., <br />~~` ~~ ~~ ~~ ~~ . . <br /> . ~ O.k ~ <br />. ..L . s.. q; <br />• <br />- L, L~~. ,~.. C( Vl W. <br /> SAMPLE <br />MEASUREMENT ` <br />~G <br />O ~ <br />~ _ <br />r ~ 1 - <br /> v <br />(~ <br />Q µ~ <br /> <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 /> ~- <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF UW TNAT 1 HAVE PERSONALLY E)IAMINED MD <br />AM FAMILIM MATH THE INFORMATION SUBMITTED HEREIN: MO BASED ON `\ / ~ ~ <br />'~ TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOq ` <br />~ ~ <br />~` <br /> OBTNNINQ THE INFORMATION, 1 BEUEYE THE SUBMITTED INFORMATION IS / <br />~ <br />1 <br /> TRUE. ACCUMTE MD COMPLETE. I AM AWME TNAT THERE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING l I'l fem...-• _, y.A_ ~~_y. <br />- -~J <br />~ I <br />7 ~ L <br />1 <br /> , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. BEE to U.S.C. 1 1001 MD as / <br />SIGNATURE OF P111NCIPAL EXECUTNE ~ 1 <br /> u.S.t. ~ rate. /q.uron. Isar swr mema mry IIrA.de lvwa eA ro i x0,000 <br />TYPED OR PRINTED and e+mv+rrun i/W/aNnNnt eYNr+em sAaIldM.ws yw.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANA710N OF ANY VIOLA710N5 IRe/eisnce e// stfechmsnGT he/sl <br />. , .. c . r . • r' ~ '.1 ; . ... ~. . . , L .I ~.^ ? rt J "~ , ~) ~ ~ ~ .. ~ I. , ,. .1 T i . v ' P T tl ! ~ ; ! 'r f ~ ~ ... ~ e " ~ ., . ~ I , . ~ .. <br />,11 I' (. <br />~J- .:r :..:C ia.:F(.. ~L.: /,I' .. ti,i A.(1;: r. ,:~,.. 1'I~.."v .. i~ r. _I.,~ 1: !'. 't" ....-''f ~~i •JP ALi. <br />EPA Form 3320-T (08-95) Previous editions may be used. (REPLACE6 EPA FORM T40 WNICN MAY NOT EtE U6ED.) I~ II ~~ 1 7 / ! j '.: 1 :1- U 9~ 3 PAGE : OF <br />