Laserfiche WebLink
f4RMITTEE NAME/ADDRESS d+rA,drisleryNs//arnnsr rJDIC....q NATIONAL PoLLUTANT DISCHMOE EUMINATION SYSTEM (NPOESI <br />NAME - ~' t Lr A{ W ~ / C DISCHARGE MONITORING REPORT IOMRI <br /> ..~ ~ <br />.,. y 12-161 f7-191 <br />ADDRESSR•{~a _.Lr ^T ,9 "il 7D04UG OOO li <br /> LI (2 L13 ~ V I SY lr ~ 127J PERMIT NUMBER DISCHMGE NUMBFT <br />,r / <br /> ~ ' <br />• <br />•~:.w.?~;Y :n <br />~r,•r¢/ y <br />1 <br />"+•+l 8oa37 <br /> / MONITORING PERIOD <br />FACILfTV <br /> <br />Y_'. - <br />T YEAR MO DAV YEAR MO DAY <br />LOCA <br />ION ~ ;, .~ r) ,. 3 ..Yr ~ a a. Q t r ' 7 r1 l '1 q j FROM 9 1 U (- TO 4 t* r <br />:l "' ""~ : " !~ r R f L "' ~~ ? . /2621/ 122-231 171-751 /262)1 I2g-291 /30-311 <br />Form Approved. <br />A,^nTr -,;fir •r t•^,-•t:;~:OM81No. 2040-8004 <br />Approve expi se~05'31-98 <br />T' - FS /FL <br />'I'•7: , <br />NOTE: Reed Iratruetloro be}ore completlnp thb form. <br />PARAMETER 13 drd OnlYl QUANTITY OR LOADING 11 Grd Ontyl QUANTITY OR CONCENTRATION NO• FgEOUENCY SAMPLE <br /> (4663 (546} 138-16 14663 646/ X V <br />0 <br />132.3)) E 815 <br />N1/1 <br />L TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /es-s71 (6468) 169•)01 <br />:,CtiO 'iT~.T,,F UHHP R"•rl SAMPLE yp gry:p ~^;i r. ;tg ^r-;,.+::'.a: ... ... -> ( ~)) <br />C i': ~: 10 it h "'+ S I R MEASUREMENT <br />TL."S3', L U 7 ~.::'PERMIT.'~.'~ <br />~ :::..~~^'a<x~,^•'::.: <br />: :::;c:G~ti`:~wrt~.. <br />: <br />~:. y`I^ 1~/iR.: ~ <br />... ..a^9L;~~71»:-:. <br />: ~.4~~x-:<~ ^*•- : ~'.'!`.~:'.1~(::' :~''~f~P!~: <br />-- - _ .. <br /> <br />.. F. 1. .V '1 <br />v a t. 1 _ RECUIREMENT~ <br /> <br /> <br />' .:.....:.: <br />.:.. ...,t .... : <br />.:.. <br />,:::::.;~ ~ <br />. <br />..; <br />~ <br /> <br />.. ~ . ~ t~ +L~ r <br /> <br /> <br />....,. <br /> <br /> <br />. <br />L,.'.0 ..Ti. 4Lur E -11 SAMPLE a;, .., .^..rfr:E<: +tfi0.. .^.ts::. ( ?1) <br />(, T ~. ~;•!, :, ,1. ~.: _~. MEASUREMENT <br />^a•r~,r , n n <br />I :; .PERMIT~::.~: ~ O~Er.g'.,;;+':': ':.:~Y~o.~'sr.vs':. Raa '~:iL1E7;'.:.';;~~.':::;'~.:':: ':;.':::q~,+[e45,:~ ';?:~'!¢'![1;!iG.Stt:~. ,vN.. ':'::~:':::' yT`:~fi.I:..Y.. .'?:+.3<1~ <br />-~ c ::. I r ` ~ - a ~ p ~ ~ { r REQUIREMENT . ~ :: ::. y .'s ^; L- <br />R1LT YR:~.f~f !' -: <br /> <br />;. c' <br /> <br />c a T <br /> SAMPLE <br /> MEASUREMENT '~ <br /> .:'.:.PERMIT:..: ~ .. ...: . ;~ .,... (\ <br />.:'. ~ [/ <br /> REQUIREMENT ~ ~~. ~..~~ ~~ / <br />f <br />~ v ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> ' ~ :PERMIT.' . ~~ . .. <br />-.. .. . <br /> :REQUIREMENT ~ ~~~~~ ~'~' <br /> SAMPLE <br /> MEASUREMENT <br /> :.:'PERMIT ~: ~~~ .. <br /> 'REQU.IREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT ~ :. .: .. ... <br />'..... <br />,.... ~.. .... <br /> <br />~ <br />~ <br /> <br />~~ <br /> <br />.REQUIREMENT <br />~~ ~ <br />~ ~ . <br />~~ ~ <br />~ <br />~' <br /> SAMPLE <br /> MEASUREMENT <br /> .`''.. PERMIT ..~~~ ~ . ~ ....... ~~ .. .. <br /> :REQU.IREMENT.. ..:. :~:.., .:: :~:.:~:.'~:;::._ :';~.';.::: ~. ~_.. ~ ~:::. ~ ~.. ~'. .. <br />~ - -- - <br />~~~~ <br />NAME/i1TLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; ANO BASED ON TELEPHONE DATE <br />~` <br />1•' <br /> UIgY <br />TH <br />DIATE <br />RESPONS <br />BLE FOR <br />MY <br />NDI <br />D <br />LS ~ "'' <br />~• (~ )G r <br />~~ " ~ INO <br />OF <br />OSE I <br />VI <br />UA <br />IMME <br />LY <br />I <br />OBTNNINO THE INFOgMAT10N, I BELIEVE THE SVBMITTED INFORMATION IS '+ 1 J <br />~ <br />~ ~ <br />I <br />1 <br />~ <br />G <br />/ TgUE, ACCUMTE AND COM0.ETE. 1 AM AWARE THAT THERE ARE <br />9GNIRCANT PENALTIES FOR BUBMITDNG FQSE INFORMATION <br />INCLUDING ~. <br />~ 1•~(~, !~ J t <br />JL . 7L ~ (C' 1 I <br />q ~j <br />(j ~ ) <br />' L <br />~ <br />~ . { p <br />e , <br />6 . ,~ ~. ~ P , <br />1 A <br />T <br />IB <br />T <br />F R <br />P <br />EE <br />S <br />C <br />1 <br />D r I <br />I HE POSS <br />Il1 <br />Y O <br />NE AND IM <br />RISONMENT. S <br />1e U. <br />. <br />. <br />100 <br />N <br />73 g(ONATURE OF PIIINCIPAL EXECUTIVE <br /> U.S.C. ! t7te. /PWWtlM ut/r N.r. AMVhr nrY hct.~. hMF ry ro t IO,000 <br />TYPED OR PRINTED .ns armuirwn inp(vnre¢ar e.r..«n a nwnNS W e rrera) OFFlCER OR AUTHORQED AOEMT CODE NUMBER YEAR MO DAY <br />GUNMEN 16 AND CAPLANA I IUN V F Arv T V I V LA I IUrvO (rtere/NCI se efIeCIITIOrs ne/6/ <br />:;~' l.r:. /, PP --)r ,..,: '1 ..,•~IL~- '1= r.,, nu^~-, CJ". - .^^~>" L•-'•., _ ,wF°i ;"Tr~E.r ;- - ._. .. ,.T.-,. T, <br />L`'P~AL ~. -„ ..L„-. )?:1~._w_ r,.7 F..l.,u ,1~'i^- ".YTr'I^v Tn.,~ OT~.~•:r ,. ~,. .-.... .. .•• <br />iucn 3aJ ET. ~Y fr ~lcw JY CGNw wn cDe <br />EPA Form 3320-1 108-961 Prevloue edmone mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE U8ED.1 r~,~ (~ .) ~ ~ .; {, { ~ _ ~ .) PAGE ZOF <br />