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PERMnTEE NAMElADDRESS QiArilaihryNr'Lurmaw yOlaGwp NAME S.N.. (.4 .- 1{L ~u:'~. n':i ADDRESS ~ r' A . ? rt L: i!4YU!:'It <:U dlbl~J FAaLm LOCATION.;, N Y O '. ~. C J n l t?! MATIONAI PMIVTANT DISCHARGE EIIMINATON SY4TFM /INPDESI DISCHARGE MONITORING REPORT /OMR1 rr~cnn~:. ,t ni ', PERMIT NUMBER d9CHAR0E MUMBEA MONITORING' PERIOD YEAR MO DAY YEAR MO DAY FROM .OQ 10 ~ TO JU :i !I :?: ti "I:.Oh ~4, (3UUt? is ii) F - FLFAL N!iUIi i'I3C8:i?". LL SAi;L CnF.Fv l":v4• it J ~ l J1. ~~C~~1' I I :"': [' NOTE: Rnd brtruedotr b~1a~ compMLinp thM tam. PARAMETER QUANTITY OR IOADIN O puality or Concentration NO. EX mE Gan' SAMPLE T PE AVERAGE MAXIMUM NITS MINIMUM AVERAGE MAXIMUM UNRS ANAtrme Y J: L AN'I G ~ k:.: SAMPLE MEASUREMENT : YI`. ;t fl ~ yq~ tl ~::}at,::~: . ,;:{: k:. .. : ,: ~:: I ,_ V I .i U d L v V ~s "'IJDD 1 U C: '~~~PERMIT.~~ -..:. .~ ,;>=,;9~~~ ~:.;;'}'"r . .~'i `:<k' 35=1 a~~m:!=:~=is+`:~.~ . - r::-::.. ~~'sf."~i?/. '"'~'?.L _ ,~ L J ", 5 V t !. ;I . F'FL'JE . REQUIREMENT .. .., .. ::.: ~ ~~~ ~ ~ . ..... . .:~' ~t.~rati ...,. ... SAMPLE MEASUREMENT ::~~. PERMIT:~~.~.' ~ ~ ~ .' :. ~ ~.~. ,.. ~ .: ~ ' r.~ :REQUIREMENT ~ . ' ': ~ ..' .: ~ ~ ..:. : .: ' f ~A SAMPLE MEASUREMENT ..:':..PERMIT : '~ ~ ~ :.. ' . .: : ~.. . ~. ~~ ::~.: .... :... REQUIREMENT .. :: '. . . ~. ~::. .: ~ . SAMPLE MEASUREMENT '~ ~~ ~~ PERMIT. ~ . .. . ~ . ~ ~ ~. ~~ ~ ~ ~ .. REQUIREMENT ~ . ~ . '. ~ : ... ~ ~ ~ ' .. ~ ... : :. SAMPLE MEASUREMENT .....PERMIT.: ' :.. .. ...: .. ... REQUIREMENT ~ ~ ~ ~ ~ ~ '..' .. .. .. ... ~::.' SAMPLE MEASUREMENT '~ 'PERMIT.. .. ~ .., .. ... .. .. REQUIREMENT , '... ; SAMPLE MEASUREMENT ~ ' ~ PERMIT' .. .. ~ ~ .. ... ~ ~ ~ ~ .::.µ ~ ~ REQUIREMENT . . . .. ~..: ,~ . ~~ ~ ' ~ ; ~ ~ ... ~ ~ . .. ~ . .. .. ~ .. .. ... ~; ' .i. : '.. NAMERTTLE PRINCIPAL EXECUTNE OFFICER °""~° •r p•"•'r° •wN.l lh ' h tl°rumenl.M YI .II.rhrRntt Overt TELEPHONE DATE prtp.rtE nMer m/Elnrllun ar wp erMon In racurd.ntt.Rh•nrrem Od ned t 1°aeurt lhrl qupllON pemnnd pr°pe"/plher .Itl m.Na the lnlarm.lbn 1 ,f vbrrium. t..a °n rt/ I^9mrT °rur perm, x penom wno mul.p ur n.l.n. ~ ~l' C^7 ` / \ e.lhue prmmalracnr rvp°MeY rwpmerlwq urlnromr.u°.r, u. w°rrr,.unn ~ l `~ ' _ _ mbmllled 4 1° the ber of m/ YnewYdpr .nJ beper, true, R[Ynle..rrtl nmp44. r pm...rt u.l lhrrt .n tltNDnnl M.IDU ror wbmllD htr l r u /- BIONATURE OF Hi1NCIPAL ExECUTNE ~~ ~' p nt n urmr m, I d di M tlblll r TYPED OR PRINTED _-.--. ._ n u ngl pm tT O nM.nO lmprMnmenl rorbnu.lnq "Neu°ra OFFICER OR Alft110RIZED AGENT CODE NUMBER YEAR MO DAY bvmmCnlJ /ervV Cnr~nnnrrvn yr nnr .rv~nrwas IrtIII/IOCI N/IrrICOTMri O//// I+iC+M1 LI .ITS BILL-- AAIV?iJ ~~ S:.J:LEht1LI SOLIDS iIRIT APPL':?[ 'C:' <=[.~t:,~~'i[i'' Pt.tCiP EVENT; T_5 !a~;+ LI'1I'f5 ~AIYS~ r!.:• >1(~Y';.2([N Ph:i::IP cVftrT SU£JFCT YOt-:U4Dc) :;P rit~77F :.'•' I.d._'. OIL G C;RcAGF. - .,F.c EPA~Famtaa20•t (Rev~3/99) Previous edilioris ma3 be'useti: ~ "~~ ~ ~ This.is a S- n form. PAGE of q 00053/uul; / L 1-iaDU 2