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PERMITTEE NAME/ADDRESS Rry6 irWryNaw/!cc•nm r/orDi.nn) <br />NAME CY~-`U_ ,.. 1 _., _ - ~__~. <br />ADDRESS CI I'T'-~ -, , _ ).t 4 P ~, <br />,~~ f3i'iC LE~'177 C~ .^155 <br />FACILITY <br />LOCATION <br />.,,..1. •7e r.7?aiS :!. Cc, ,.r LV- -;t. ..,YY <br />NATIONAL POLLUTMT OISCHMOE ELIMINATION SYSTEM INPDE$l <br />DISCHARGE MONITORING REPORT (DMRI <br />Z-161 117-791 <br />"lQ^2~?~! ~^l <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM ~ -~ V TO it ,r /I (. <br />tlnJrl bJ. JTI /JLJSI tl/AJ71 !JB-J9/ 13Q3// <br />Farm Approved. <br />u • „ c r, ••..- .~ -..~OMB,No>2040-0004c c <br />r ApprovalI eXD,ires 06-31-98 <br />- r". " E f <br />T: <br />! NOTE: Rsed inetrucUDne belora eompletinp thle form. <br />PARAMETER 13 Grd OnIYI QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> 146-531 154611 138-451 11653 !54611 <br />EX OF <br />TYPE <br />131-371 MALrsIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVER <br />AGE UM <br />MAXIM UNITS rsJ-ssl !64-681 169-701 <br />i i:J !I, (A jA ~.... ,-O., .:.; .t ,~.. .. r.....r-. d <br />o <br />I$ p <br />~1~a ( 'a) O ~ <br />~ <br />(/ ~KAB <br />c~) MEASUREMENT ! . <br />J <br />11 JIL `J 1 !1 ') PERMIT Y:i't :: 'i'`• .''.H-#,k i,: r'T~ kw.t>.n« 3•ri 'T•() I .vrF/ :aAa <br />;:FAL[)e:':? '~~U' ; VT.L7: REQUIREMENT ^-R? IDP,A A41' hSTT.T 'T )( F•„/T. N7'p <br />~L_;i, fY CCLI :1 rlLr r1 Lj SAMPLE ~/ q <br />~ <br />~' <br />1 yy~~ {O, <br />~2 <br />~ ( J3) t;: -':7^ kY,:=•: i,:.. ar t..:~: ~>-:.:~ <br />~ <br />~Q <br />5/ <br />l'dQU 77, i:.i t'MFIIf PI,S9T MEASUREMENT r <br />1 <br />1 0 <br />Vr ^ c <br />~UUSU 1 U D PERMIT n:;[=BRA PTI~"3AL a###n# #c~Y-.#:~ ~aa'-C3 .: #t^ SBKCY 'MST+.'+ <br />..r PL;)Eh?' :s Y;?is V~LUE ~REQUIREMENT 3UD4 ;Vf; I LY MT <br />D <br />' .4rD ~ ~'<'kt <br /> . <br />. <br />7LL AHD ;H°ASP. SAMPLE ra: .`•.^•;~,° ( .lq) ._.1: =`•rA ...,.. .-;: Lr: r; ::::~ jj~~ <br />5/ <br />V <br />L <br />r <br /> MEASUREMENT ~ V .3' O ~ <br />~ <br />Y I ;UAL <br />'i765 ~ O D PERMIT ..F.;c:Y 7 • °5=1 :;.x~....- :x>;"k#r'" c;:.,.t... 4 rv,:Lr ,r^npr <br />:. r'•'LUEMP SRJSS v4r Uv REQUIREMENT ~ Tid S?' !IAC VO=7 -'°<: <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 CERTIFY UNDER PENILLTY OF <br />1 <br />E INFO UW THAT I HAVE PERSONALLY EXAMINED MD TELEPHONE <br />RMATION SUBMITTED HEREIN; MO SHED ON DATE <br />ti <br />t;ichard iYtl'I$ AM FAMILIM WITH <br />N <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMIRED INFORMATION IS - <br /> <br />lt TRUE, ACCUMTE MD COMRETE. I AM AWME THAT THERE ME <br />FORMATION <br />INC <br />UDING <br />)7O 870-271J <br />S <br />9B <br />anac~er <br />Environmental , , <br />L <br />SIGNIFCMT PENAlTlE9 FOR SUBMITTING FALSE IN L 1 <br /> THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD 3a SIGNATURE OF PRINCIPAL EXECUTNE <br /> U.S.C. f tale. IAVWU•. uvr tler •Ynm• rr,rY lAr/W ~ a rp ro r10,000 AREA <br />TYPED OR PRINTED •nsamvimnr brpianrTr o/GM••n smarN••rM6 vwA/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS IRsrerence sn errscnmenrs Here! <br />;, ;.1 "aVl'Cs L.".TT°, -r)r. r~i5, Tq~V >""'L°4RLE :7LZR^ fLD' '7TH v ,~.~Iv ~= r_~r,r rl_,~ ,~,-.CT' ,:cr^ <br />CT. i,j'!D• 5':, _.. •fE n' T.", FOI: tiJRDr'~ 'JF p?7~° 1°:•):'/LM'° .-~ nr• r -.r 9r _-. r. rr' `I ^/, ' ~• <br />..?1 V T 1' ^r• ^r4^ rN-Tn~I~rr _r. ~r ,.. n+r ~r _ <br />EPA Form 3320-1 108-961 Previous editions may be used. (REPLACES EPA FORM TaTO WHICH MAY NOT BE USED.1 i IT„~ „ / ~ ~ „ r. _ ., _ , ~. ~ ~ PAGE ~ OF <br />