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PERMITTEE NAME/ADDRESS (1ryArd.FrdrryNw/L«aNm l/Di)jirmp <br />NAME K :' ~?„ ~.' <br />ADDRESS ~ r-~ 1 " <br />r'.~_. <br />FACILITY <br />LOCATION <br />.. ~ ~ <br />NATIONAL POLLUTMT dSCHMOE ELIMINATION BYSTEM INPDES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />11-151 Ir7-19 <br />C0;5SUC3fi COT A <br />PERMIT NUMBER dSCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM i ~ TO ': 1 ,. ' <br />/16171 /77-131 /11-15/ 176-771 /1f1-191 !36311 <br />Form Approved. <br />P. D 7 F C k *` T O I L L I~MI~INP' ;paq.0°oa <br />Approve!, expires, 05-31-98 <br />r _ ~TI,pL <br />'"Ir,C t <br />NOTE: Reed InstructloM belore completing this form. <br />PARAMETER 13 Grd On/YI QUANTITY OR LOADING l4 GW Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> 146531 154511 /35451 146531 /546N DF <br />l37-371 EX <br />MALY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l6Z-691 164691 159-701 <br />-~~ SAMPLE r..-. ... ( 12) <br /> MEASUREMENT <br />Id~~ i .. PERMIT ~.-. :-:pu .. .. .. h.S 4#:-".. =:;;~ `l.Q '.°:7f'LY <br />, .."~;il Tti <br />f N L,'.: N 1 ='- ~/ ' I, .1 REQUIREMENT H T !: I h G'± P 18 r° • ,,; ° • i <br />,: L,L IISE - -. .Lt SAMPLE ~.,-. ;. r,ti0 ..'C:::i ( ~`') <br /> MEASUREMENT <br />I ',i _i.r~ 1 ._ PERMIT ..:F -v`.:`- ~'%'r"~+~S ~k Y. ,=#~r'+',1# ;>,1 Y><.'t=t C.5 iYC =:/ ;I{AB <br />' i; L v ~, :r T V 6 (, U ~ REQUIREMENT - T'. 1 +: (Y x h N 7~ <br />_L:. n,+~ v'.:_ ~_ SAMPLE ., ..-.#{=° -.,... .... ( +"I) <br /> MEASUREMENT <br />+ ~: L v .1 PERMIT <br /> <br /> <br />.. <br />`"- G <br />. '.:.,...:... • ~ ,::; ;: {: f -~ .',... " <br /> <br />,,. .. <br />, <br />{ ;: ~ ' . <br />, . -( r. <br />. <br />'07TIti <br />;NAE <br />.. L ~ i+'i G N J (i J V A :. Ii. REQUIREMENT C A T I Y K% L <br />, ., 5 5 T <br />~~-. lv CCI r1U1'IT (1.': SAMPLE ( i.,.i) f~'C-'~°~' ,. '~LG".::: ~: <br />.., TFdn~i He N'!' YLA '.; MEASUREMENT <br />-emu 1 V 0 PERMIT PTIONAL R`.?C'iiT '~%. •. •, .."~i'< .^.^'~; "J~:>/ 'ti_T.4S <br />LU E:r'i Gk0$$ V- i" REQUIREMENT jUOfl AV,: LI ''.I i.V :17, f1-5 <br />._...:. <br />-~ .a;lt ^'v <br />. ~..; 'J :iF TGTAL SAMPLE :##= "}'.: "'~' ^`- -~+ <br />_ .j L y V MEASUREMENT <br />1Jc ,'3 i O i, PERMIT .. .:: i~ -`~:,=?:.`{: .. <br />~- ~-.CX"','. ,.. .Nfi. .~ r,t Ff';t~ y <br /> <br />.. .u. <br />F <br />t t .. l; E d T ., i. ::.1 i, !! " REQUIREMENT :;:::~ ; (. A I ~ Y "Y , L <br />.LL. A>. C' Lit. SAMPLE ..,-•` ( 9U) ...^, f,.{ ;'.., .~. _ <br />'+ L .:. A L MEASUREMENT <br />K J'~u .. ' PERMIT <br />.... <br />,.~. ~2:PO:,~ ?_=i <br />....;, <br />.<Y:~v <br />w....~., <br />,-., .r <br />.:....,,.: . <br />., , <br />.,.. :~ <br />or'}+.Uc:rs'_ ~ - REQUIREMENT ~7'iSm .:,y ;=li <br />: m. <br />„~ <br />~ <br /> + < <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUi1VE OFFICER I CERTI <br />MA FA FY UNDER PENN.TY OF LAW THAT I HAVE PERSONALLY E%AMINED MD <br />MILIM WITH THE INFORMATION SUBMITTED HEREIN <br />MD BASED ON _ TELEPHONE DATE <br /> <br />t,~~ <br />(?Chard q..1411T1SOTl ; <br />MY INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFOM/ATION, I BELIEVE THE SUBMITTED INFORMATION IS' l <br />~ // // <br /> <br />I <br /> <br />- <br /> <br />+-SCE Fre Gident TRUE. ACC(MATE AND COMRETE. 1 AM AWMF THAI iHEflE MF <br />SIONIHCANT PENALTIES FOR SUBMITTING FN <br />SE INFORMATION <br />INCLUDING -- r ~ t r ~ , - / <br />~ ~ <br />" `I ~ <br />~J ~C ~z3-x+721 <br />~r <br />~l <br />~5 <br /> . <br />, <br />THE POSSIBILITY OF NNE MD IMPRISONMFNT. SEE 16 U.S.C. ! 100+ MO ]] <br />U <br />S <br />C <br />! 1710 <br />lMWLY <br />IM/ <br />M <br />bM <br />I <br />I <br />f <br />F <br />OD BIONATURE OF PRINCIPAL EXECUTIVE y <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />A N <br />+ <br />S A <br />.a mry <br />n[ <br />Y61 <br />YNAW ro <br />IO,O <br />An/r+rwhsn. inEdanwrr orbwwn6manNaAM6r.An.l <br />OFFlCER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />..vmmcn I ~ nnv cnrcnnn i rvn yr nn r vivcn ~ wiw Inemrsncs sn euammsn+s neTe/ <br />. \..I LGn I. :. .i~,L1lI_° L:."! +~~L ~l .,i !',. Lil'{~~ i4-4a 't?.LLr .. i' n i.F 1F( ( '+':., `_V ( .~~ .. IT' i I <br />1. r. <br />.'d-aL L...i.~i. .. .,. :i~;Jt.,+.;_'1c;r '.n:,.\::L..::.~+i Pi.99 .lug I-:-~-., <br />EPA orm 3320.1 108-95) Previous editions mey be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) PAGE OF <br />