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PERMI7TEE NAME/ADDRESS (7Mi4 F'x0~ry Nrr/Ixalon UDIG6mn) NATIONAL POLLUTMT DISCNMOE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT IOMRI <br />F,A3T~ID° CJAL ~~7PANI, IN::e n-76~ n-IS1 <br />ADDRESS dAS:SIn~ '!IN°. ^~^:7 fJt ~tr t <br />P e 0 e N J R l U 1 J] 7 ~O PERMIT NUMBER DISCHMGE NUMBER <br />JA.t ANTD'lT~l TdJ7~~J 77 <br />CCCCCC~~~~~"'''' MONITORING PERIOD <br />FACILITY E A ~ T r I U .`~. .^. ~ A L .'.:1 S p A N Y , ~ . ~, YEAR MO DAY YEAR MO DAY <br />LOCA710N $ I L.r •/"'~ T ~ ~ ~ FROM J L IJ] J 1 TO U l .i Li .i D <br />A T 1 k: S T~ O N E N r. T F_ : P %, v p j i J~~r G :J-R~C J m I?0.711 177-131 174751 /16]71 URJ.9I 19Q311 <br />~~ 'III IIIIIIIIIIIIIIII <br />sFn: PoNn i ~~ sss <br />F - .FINAL <br />11I'JQR <br />:k t::: ~i rl 1) I i i ti A i. r 1~ v h k <br />NOTE: Rased inetlvcliau before plstinp this form. <br />PARAMETER !3 On/ QUANTITY OR LOADING !~ Grd Ontyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> It l 154671 136-Jlbl !46-53 1546! OF <br />137-37) EX YSIS <br />MN TYPE <br /> AV GE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167.671 . <br />164661 /6&701 <br />PH ~ SAMPLE ~; k,^^. ;; ;= fifit: ,`-R:k <br />'-~` !`fi <br />( i%~ <br /> MEASUREMENT <br />U01J0 1 D J PERMIT afiaxx;L :sfi>nu4a ; ;A,-r: 5,5 ##u:t .•, 9,0 iErRLY [N~21• <br />~FFLUF,NT J;{754 YA REQUIREMENT #-:nC R r lei H rr nr c r <br />SDLIGS, iET*Lt':A''13 SAMPLE :k,?.~.t:tt$ h:k$'Ak 4;A4;:{. rGY :':>r ( 25~ <br /> MEASUREMENT <br />UUS45 1 v 1 AERM17.. fiik~x:r X:. 'kfifiY;tfi .ems ."-:tfiy,#+ +i fFC'v <br />'` ! <br />~D~iS ~ <br />7yC$/ <br />i$1l$ <br />a <br />tP. LUF.NT JHD33 YALUP REQUIREMENT :a/;:fi T N NE 7 Tu <br />DIL AVD GRF'A~8 SAMPLE aafifix4 ~n.,t:;;fi raaa~Y :F•::fi $8 ( 19) <br /> MEASUREMENT <br />U35tl2 1 D U PERMIT ;~+,~y.k:?~ ~ '.54.`fi.7# { 4"-Y.` Ofi:Y ;:2t Y-s ~: tk:F# # ').'3 ~ !i1 )1'I'XV 'vNAP <br />GFFL'JENT 7R755 Y ~-'{C ~REOUIREMENT >a>0#a ~h. 7I x' H^. ~1'vrT <br />FL'Je, IN ~D:7DUCT 7+ SAMPLE ( Dj) «Y, ~-,~ .~,~ fi?;Y~## <br />Ttt RIJ TRc:A T'1ENT PLR i MEASUREMENT <br />SUJSU 1 0 D PERMIT OPTI]>rAL REP?RT ::A3:3}?4 #ur~ n .;.#'.;::~.;t : :-:tr,: ;;. FF.EKLY [H5"1. <br />EE'FLULJaT :JP.JS.S VALUE REQUIREMENT TU t'r fry,- '~ F~:ft': <br />SOLI:US, TJTAL SAMPLE ;kO xCkG fr r; {: (: I;r {y taaaas r,~,^^- ra ! ? ~} <br />UI iSOLYED MEASUREMENT .. Y' <br />702tJS i U D PERMIT. ,"F~.aY:Ytt ~a#aaa :"q: afi~ra=,:;T ;:e:a#: ': REPO1tT ~ ITRL4 :RACt <br />EFFLUiNi JR7S5 PA ,JE REQUIREMENT J: T: .-R4 :i .Ty a Nr r <br />IL Adu GREASE SAMPLE 3aa$`.a ( 9Y) aaac:xt. aaa '„)+h a#afi#a <br />'/ I S U A L MEASUREMENT ~ <br />~.406b 1 D D PERMIT r,-ui~::_;j`. REPDRI ES=1 3itafi~+ asl#Yt :_ ^31#IR#o14 t :#. :: I I°{Cf./ 7TSDAL <br />.:PFLU::.IT ~R033 YALJ'r' REQUIREMENT ST R I' N -D firYtr . mR <br /> SAMPLE • <br /> MEASUREMENT <br />PERMIT <br />1 REQUIREMENT <br />NAMERITLE PRINCIPAL EXECUTIVE OFFlCER I cERn Fr UNDER PENALTY of uw THAT I NAVE PERSONN.Lr El(AMINEO AND TELEPHONE DATE <br />AM FA MILIM WITH THE INFOR MATION SUBMITTED HEREIN; MD BASED ON <br />' <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR 7 I <br />`/ ~ // ~ <br />~ ~ ~ OBTNNING THE INFO WAATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />TRUE <br />ACNMTE <br />ETE <br />1 AM <br />WME T <br />RE ME <br />D <br />T T ~.~ / ~ 1 it ~',(_-_ <br />I <br />! ~1 <br />~ <br />~~• ` <br />~ 71s <br />Q , <br />M <br />COMPL <br />. <br />A <br />HA <br />HE <br />SIONIRCMT PENALTIES FOR SUBMYTTING FALSE INFORMATION, INCLUDING <br />THE POSSIBI <br />IT <br />RISO <br />OF ! <br />/~ <br />~~/~ <br />_ _ ~ <br />iJ ~~~~jj ~p. <br />~/~ ~ <br />' <br /> <br />~~ <br /> <br />~Q <br /> <br />// <br />~ L <br />Y <br />RNE MD IMP <br />NMENT. SEE 15 U.S.L. ! 1001 MD 73 <br />f t]te <br />U <br />S <br />C <br />r mroh <br />4 <br />lM <br />ro' <br />W <br />e <br />A <br />d <br />r <br />!10 <br />000 610NATURE OF PflINgPAL EXECUTNE T> <br />aJ <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />r <br />e. t.I <br />r <br />r <br />c <br />l <br />~ <br />nea ~ ro <br />, <br />. m.Y <br />eMr+nwewnineda++wtt a/Mfrwr6manfM eM6Yelval <br />OFFlCEfl OR AUEHORRED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />CUMMCNIS ANU CArLMIYq IIVn Vr XIYT VIVIP.I WriD IROIeleDCl en ITTeCn/neR ES nI/BI -- <br />SdTTLiA$L~ iDLIDS LI`1IT aAIVF;D FOR 17-Y R, 24-RR Ph~'~Ip EIESi SUr9Jc.:P :0 l"''f1F"I C^ F:OC: P.'"`!IIEB.".L':TS T1; <br />PAHT I~B.1.D, P,;. h. JTOR'fdA2?R -"•.RHAJP.'1f.YT PLAY D;1:: 1-L-iJ. <br />EPA Form 3320-1 (06.961 Previous editions mey be used. (REPLACES EPA FORM T30 WHICH MAV NOT BE USED.1 PAGE OF <br />