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<br />PERMITTEE NAME/ADDRESS pkra. FrWryNa/Loraum (/Orpr.n0
<br />NAME C Y ~~ .i .~ - " - ', - v .' .~ .
<br />ADDRESS "1'VS:i r7 ?I",L „~~r -n. .M1. Dr
<br />FAGiCITr
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNMOE ELIMINATION SYSTEM /NPDESI
<br />DISCHARGE MONITORING REPORT /OMRJ
<br />II-I61 17-191
<br />:'7(1)27154 '1!Tl •.
<br />PERMIT NUMBER DISCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 'a V1 TO "' r'ry an
<br />nnPn niP?I na-PSl /767)1 UA-391 rir!-.?fl
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<br />Form Approved.
<br />,..~OMB~No,.12440-0009: v
<br />APProve~ sxp?Spq 05-3'1-98
<br />NOTE: Read Metructiwla balors eompletiny thu form.
<br />PARAMETER !3 Grd Onlvl QUANTITY OR LOADING !~ Grd Onlr) QUANTITY OR CONCENTRATION NG FAEOUENCr SAMPLE
<br /> (4653 !546/1 l38-I51 146-531 !54611
<br />EX OF
<br />TYPE
<br />l37-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Isl~sal ANAirsls
<br />!64581 159-701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTr OF LAW TNAT I NAVE PERSONALLY E%AMINED MD TELEPHONE
<br />E INFORMATION SUBMITTED HEREIN; AND BASED ON DATE
<br /> AM FAMIUM WITH TH
<br />Mr INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />hard htiils
<br />Ri OBTNNING THE INF011MATION, I BELIEVE THE SVBMITTED INFORMATION IS
<br />c TRUE, ACCUMTE MD COMPLETE. I AIA AWME THAT THERE ME /~ /I
<br />Hnvironmental 1.43/12 f?r
<br />y SIGNIRCMT PENALTIES FOR SUBMITTING FN.SE INFORMATION. INCLUDING
<br />THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 18 U.S.C. 1 1001 MD 33
<br />
<br />ONATURE OF PRINCIPAL EXECUTNE 9]D s7D-~7Tt < %T Q
<br />8
<br /> u.S.C. E t 71 e. IhrWbr nnM VI.Y moms m.r FxAiN rvrr rP m S IO,OpG BI AREA
<br />TYPED OR PRINTED Ans ar nrrinun Mplro+nA+r orbwwramanersW 6Y~1 OFFICER OR AUfMORIZED AGENT CODE NUMFIER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reverence se sttscnments nerel
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<br />r•ry `t - r~ -r.l ~r^^rnv _ •1 .m ~•n~- ,/
<br />EPA Form 3320-1 108-951 Previous editions mey be used. IREPlACES EPA FORM Ti0 WHICH MAY NOT BE USED.1 ^ ~ . ~ _ r„ ~. ,~., _ T „ , PAGE 1 OF
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