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PERMFTTEE NAME/ADDRESS d~r4 F.eWry Na./(awra r/DIOi..w9
<br />NAME T!IAr'rr.. ", .I , j_.
<br />ADDRESS T' r it k' V C ~ ~ ; •'
<br />~ni,.l~,~ '.:J SIhlS
<br />FACILT'
<br />LOCATION
<br />NATIONAL POLLUTANT OISCNAIIGE ELMINATION SYSTEM INPDES/
<br />DISCHARGE MONITORING REPORT IDMRI
<br />1-161 17-191
<br />.)•9I- '
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM - , _ TO - .• ., _ .
<br />!10.21/ l11-23/ 111-75I 126-27/ 118-191 I3437I
<br />Form Approved.
<br />~. (.' l I T F F F T T L' S i 7 N A~(MP• 2040004
<br />0 F y n L,) Approval,!elipSrAe b5-31-98
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<br />NIFrp
<br />NOTE: Read Imtruetiorr M1we eompletinp thin form.
<br />PARAMETER !3 Grd Onlyl nUANTTTY OR LOADING /I Grd Onlyl nUANTITY OR CONCENTRATION NO FREOUENCr SAMPLE
<br />3 /16-53/ l51-611 138-15/ !(6-53 /51-571 OF
<br />1
<br />2-371 EX
<br />ANALrsls 7yPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163-sJ! !61-681 I6'9-701
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<br />': A`..J :~ L (i U PERMIT =.~ 4gl5i ft «<k ~ ~ OvJ~'x;Xft# Y: r,.r,: 100 Ft4t?F^
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<br />NAME/TREE PRINCIPAL EXECUTNE OFFICER I c1:RN Fr udDER PENNTY of LAw THAT I NAVE PERSONULr ExAMINO) AND TELEPHONE •DATE
<br /> AM FA MILIM VATN THE INFORMATION SUBMITTED HEREIN: AND BASED ON
<br /> Mr INOUIRr OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE iNE SUBMITTED INFORMATION IS
<br />TRUE
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<br />D C
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<br />W. Gurdon Peters , AC
<br />URA
<br />OMPLE
<br />E. I AM AWARE THAT THERE ME
<br />E AN
<br />SIGNIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING .
<br />/ 70-824-4401 98 4 ~tf
<br />-
<br />PresideLLt General Efana !r ,
<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE tB U.S.C. 1 1001 AND 3J
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<br />! 610NATWIE OF M1INCNAL EXECIfI'NE
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<br />TYPED OR PRINTED .
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<br />t ] t e. /grWeY, uMV rMAr ,bNM, mrv IncAN, Aw, ye ro 770,000
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<br />OFFICER OR AUTHOR12ED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe(erenee e!( ettechman[s here)
<br />•r. r. I,n,i, PV 7-ci, FG2 (i E.TikILS t1F 'f 'i :.C k'PGi'Ei'J ~2 ':. NEP ~!?7 LC`: - e_9AiT°T CC'F I. F('1':T F.'iT C'~4'P F., dI: CC? L`
<br />1. :::uAL fJ 50., uF Tc5'[ JfiGAhI5.15, AND ATTACr. ACUTE TGYICITY TEST FEFCF7 FCpM *r• CnP, c;: [__ pE' a,LL
<br />I
<br />EPA Fwm 3320.1 108.951 Previous editions may be used. /REPLACES EPA FORM T O WNI^H AY NO BE USE .1 r ,OF '
<br />CDC']?/9~~Clli-10~.c• , ~
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