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PERMITTEE NAME/ADDRESS (/MiJ. FrWryNw/laanw dDrp...q
<br />NAME ^y~;r Ir i.. .. , .. ... .. ~ 1°P.
<br />ADDRESS nlt:: ~ I r _' ~ '~~"-~'F ~L:'1 ,1 '' P~
<br />910Q -^i _'^_L-
<br />F:,1~Le ~, _;~ ,IrT ~ ;
<br />FACam,
<br />LOCATION
<br />NATIONK POLLUTMT DISCNMOE ELIMINATON SYBTEM INPOESI
<br />DISCHARGE MONITORING REPORT IDMRJ
<br />17-161 I77-l91
<br />'707?7?;{ ^?o t
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM ~~ l L TO ' ~ ~' ~ I'L
<br />!14711 I77-731 l7b751 /76771 178-191 l3C-311
<br />Form Approved.
<br />• i ~ ~ e . c - ~ ~~ ~ v o p~rOMB~Nop 2040-0004- ~-
<br />(_-'inn sl ;~~ APProvel aspires O5-31-98
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<br />NOTE: Reed inetruetlale belore completing this lorm.
<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING l4 Grd Onhl QUANTITY OR CONCENTRATION NQ FBEOUENCY SAMPLE
<br /> 146531 15d-611 138-451 !46531 15b611 DF
<br />l31-37I EX
<br />MALrss TyPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.691 lS,F-B91 169-701
<br />'13 •:;Au•-;:/ °~"r 1. SAMPLE .. J~¢ ti.k~A,rr .-}r•: •: •:-: 1 lrll
<br />~„~^y ; . t- - i" MEASUREMENT D.Z`1O ~,~55 Q ~/3Q - i.cffl
<br />111L? ? 7 PERMIT .,-vi-vv 's$"+rC4~`. .,- r=kG~'.:f: 1..7 R?PI:JR... t 1N~:P/ :AL~1'.^
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<br />J REQUIREMENT ~ t:::cif 3~f`A A'/~ '1ETLY ~"% NS/L M: hT~u
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<br />1.I<2!' P ~ .. r_ %.~,•_ F'LA~T MEASUREMENT '11.1-~1-~ ,! 7~y0 ,3~ +.aL.~7~
<br />X0;150 ~ '1 ,) PERMIT R!?DORP %7?Y~RT P#>~*,Iixt: ,t ayxnSZ:" Yk; Clk#* , ;',:h ! RCE/ 'ALCT'~
<br />~f i'LL':-~~: ,i+79$ "6 L11~ REQUIREMENT jl~Df RQi~ DRILY °'7 !'r9 ~+'=" ~ON:''1
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF UW TNAT I NAVE PERSONALLY EXAMINED MD TELEPHONE DATE
<br /> AM FA MIUM WITH THE INFORMATION SUBMITTED HERON; MO BASED ON
<br />tt
<br />RiciTard I /
<br />~~Z MY INQUIRY OF THOSE INDIVIDUALB IMMEDIATELY RESPON6lDLE FOR
<br />DBTNNING THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS
<br />.I
<br />]CI"
<br />Environmental I'1~8ncE ,
<br />TRUE, ACCUMTE MD COMPLETE. I AM AWME TNAT THERE ME
<br />SIONIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />70-g7D-2712
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<br />/~
<br />9g
<br />• ,
<br />THE POBBIBILITY OF RNE AND IMPRISONMENT. SEE ,B U.S.C. 1 ,001 AND 73
<br />t
<br />P
<br />4 SIGNATURE OF IMIINCIPAL EXECUTNE
<br /> U.S.D. E 19
<br />e. l
<br />NW
<br />. MWr Mar ahNhs nvr INA.W n,.. w ro 110,000 AREA
<br />TYPED OR PRINTED .eeamvirNnr hrplenlrNO/btw~Ar 6nv,eYa rd 6Y~'+~! OFFICER OR AUEMORRED AOENf CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION Oh ANY yIVLA I wno lrrsnrmce en srrscnmenrs nary
<br />n .. k, I'- ,r_ •..Y ~'~i'1~ °7' ~_ "~.'_~N , ~L!13 c 'r,~-~~ ~.a;ru~c^r. •ra ~ ~T 'O'' c•~-~ n' ;ire ~ ,~~.
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<br />EPA Form 3320.1 (08.961 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 ~ ^ ~ T r„ ,,, _ ~ ^ , „ PAGE , OF
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