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PERMITTEE NAME/ADDRESS prirl FrWry Naw/Wrauu l/OBG...O <br />NAME ijr~:': }? F.I .`.1'i., T..L. <br />ADDRESS + 4 A F !' ~.. Z :" i ~ ~~ <br />b.v, hJ:i 1^7 <br />(,rtdl'. <br />_'~ cllb>o <br />FACILITY <br />LOCATION <br />t ~i T:.: B. r,p.77^`, ... ZF.l ::, ~ tri/;r a/ '1"d <br />NATIONK POLLUTANT dSCHMOE ELIMINATION SYSTEM (NPUf$) <br />DISCHARGE MONITORING REPORT IDMRI <br />/7-751 r7-/9I <br />r_cU03211s ~ <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ TO <br />176311 172-231 17475) 176171 II8-79/ 13437/ <br />Form Approved. <br />A c u T F 4 F T T F. J'[ I N roN~. 20~Q004 <br />~ 1 c Approval a:~Ire~05-31-98 <br />1 - FTDAL <br />"T`:rF <br />NOTE: Rssd Irntructlans bslotveompNtinp this form. <br />PARAMETER 13 Grd Only) QUANTITY OR LOADING !1 Grd Only) QUANTITY OR CONCENTRATION NO. FREGDENCV SAMPLE <br /> 146-531 15b611 /38-151 1~65J 15L6/ DF <br />131-37/ EX <br />MKY515 TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ml-e.T! 161-6B1 !6&701 <br />~_~lr ~ Al is F. 4H11 fi 4C1 SAMPLE ~^-t: ;:.',: ;: :,t ~.~: ~; ~: ;: ~p~r;.; ~:.. rr;y .,-A ~ `3) <br />C:;i:IUbAPiP.IA MEASUREMENT <br />A.13n 1 U G PERMIT ;:#1: 4:71:5 ~17r%'v'tt:vc ; ;~~~ 1DC #eC3:Sr,: w#K#~y,;a r Q_ THEY .,RAi' <br />r. F"L U c N T G R7 ~ ~ V A L ~,1 . REQUIREMENT !LN ~ 'Y ~ fl E C ~' f/ <br />~C,(i ~TA'In:- 9511 H,' ism; SAMPLE ,. ~S::C;: 4S~k-:;:' flt'0007 :tnCi+# ~ ~3~ <br />Yi:. r;PtinLt;5 MEASUREMENT <br />rAUr,c 1 O 0 PERMIT ,..,~.. 4.3 ;x „QQ.'. ': A3 gbA ~. ...:a1A tFe ij#::. £H~ TF.LY i;vAi+ <br />..}'FL7Lk[ GRDSS VAL';, REQUIREMENT •^.•ttt< 9'N :p3tID! CENT <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT <br /> REQl11REMENT "~•.,- <br /> ~. <br /> SAMPLE <br /> MEASUREMENT J <br /> ~ <br />! <br /> PERMIT <br /> REQUIREMENT ``_- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ "' <br /> REQUIREMENT - ~ ~~ ~ '~ ~~ ~" <br /> SAMPLE <br /> MEASUREMENT <br /> ('ERMiT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ ~. <br /> ~REQUIREIuIENT. <br />~ • ~. <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I cERnFr uNOCR PENKTr or Lww TNAr I NAVE PERSOxKLr ExAMINED MD <br />AM FAMIUM YNTN THE INFORMATON SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE IMDINOUKS IMMEDIATELY RESPONSIBLE FOR <br /> <br />w. Gordon Peters OBTNNING THE 1NFORMATON, 1 BELIEVE THE SVBMITTED INFORMATION IS <br />TRUE. ACCURATE Mp COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFICMT PENKTIES FOR SUBMITTING FKSE INFORMATION <br />INCLUDING <br />~j - ~ <br />70~a24-/i~10I <br />98 <br />4 <br />28 <br />President/General MBna Br , <br />THE POSSIBILITY OF RNE MD IMPIBSONMEMT <br />SEE to U <br />1 1001 AND 3s <br />S <br />C <br /> . <br />. <br />. <br />. <br />S <br />Sts <br />U <br />C <br />! SIGNATURE OF fh11NCMAL EXECUTNE <br /> . <br />. <br />. <br />1 <br />. lnrteEY. uNr drrr .6eR.a re/y NcArlF Aw. y ro ff0,000 <br /> <br />TYPED OR PRINTED <br />rNa muiltun hgdavtwlr a/bew,.n/monNS rtl6y.r><1 <br />OFFICER OR AUTNORI2ED AGENT <br />CODE <br />NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS lRI/IlIIICI sll srcechmsnrs hsrsl <br />-~.. I. A.~, 'rP 7-y, !'Ok DhTAILS OF TF.SC k~ROCcGURB. FE?:.P.C Lf`C - °YATT~TI~4L FfI::^' F:STI"ATP: uF'ICR t` <br />..k';hAL 1J 50; OF TE5T .;RGAkI585, AND ATTACH ACUTE TOYICI''Y TE°T FEFCF^. F01!1 °C C"F. C`:FI°5 OF ALL <br />EPA Fam 3320.1 108.96) Previous editions may bs used. IRE LAC S A FORM 0 WNI M AY NO BE US .I C C 12 8 / 9 9 C 11 3-105 t; A 1 F , <br />