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pERMITTEE NAME/ADDRESS (fweY4 FecWryNr/Lxenon dDl)1..n9
<br />NAME T !~ A i e' E. ~ '': j `. ~ i , ~- , - _ ,
<br />ADDRESS THAPl~F:; „~ ,
<br />P.U. ? t:t ',', /
<br />CRA1;:
<br />
<br />FACILITY
<br />LOCATION
<br />„1'1t.: N. GOtiDC4 P;:7! F:,, ~k5S/:,c;+ "'~R
<br />NATIONAL POLLUTMT d5CHM0E ELIMINATON SYSTEM /N DES/..
<br />DISCHARGE MONITORING REPORT /OMR
<br />1-161 ~ I7-191
<br />C09 32115 C1 C A
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ TO ..
<br />110111 111-131 /11-I6I 1/6/71 !IB-291 !363/1
<br />Form Approved.
<br />A. !^ tl l T n E L R G U LQMfl No. zoao-oooa
<br />I S U F A P a) Approvellexfyrs~0$-31-98
<br />F - FIrAL
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<br />NOTE: Reed InewcUone belore eompletinp thb form.
<br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING 11 Grd Onlyl OUANTRY OR CONCENTRATION NO. FREOUENCr SAMPLE
<br /> 1165 l5L61 !38.15 14653 161-6/1 DF
<br />/31-371 EX
<br />MALYAS TYPE
<br /> AVERAGE -MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lea-e!I 161-681 169-701
<br /> SAMPLE .II # #dCRtr# #it0## ( 12}
<br /> MEASUREMENT -
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<br />~ U S P E N D C U MEASUREMENT '
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<br />N, SAMPLE #r ::k'. ;: :+k.^.#: :;: #####>: ( I Q}
<br />(ASS' FF.) MEASUREMENT
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<br />z:FFLUENT GROSS "JALU REOl11REMENT #4:`•? a€I: A. AYG :'.;1liI.tlY C;g MI;/L
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<br /> MEASUREMENT •
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<br />/Nit:; TeEATF1ENT FLAN MEASUREMENT
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<br />cFE'LUENT G.R75S YALU 'REQUIREMENT 30DA ILiG` DAILI ~};. tlGG #'~~:#
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<br />`,1SSOLVED MEASUREMENT
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<br />':..DA21Y tRY
<br />MG/L
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERn
<br />AM FA FV uNDEn PENALTY DF
<br />MIUM NATN THE INFO uw TNAT I NAVE PEnsoNALLr ExAMINED AND
<br />RMA710N SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br />
<br />W• GOldOA P~Ctels MY INQUIRY OF TNOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19
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<br /> TRUE. ACCURATE AND COMPLE
<br />I AM
<br />AWME THAT
<br />HERE'ME
<br />E.
<br />SIGNIRCMT PENALTIES FOR SUBMITTING FN SE INFORMATION
<br />INC
<br />WING
<br />President i Glnarel I'1Ena eL'
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<br />THE POSSIBILITY OF FNE AND IMPRI90NMENT. SEE to U.S.C. 1 7001 AND 75
<br />i10NATURE OF PRINCIPAL EXECUTrvE SI ]D 824-4401 99 ~ 1 25
<br />
<br />TYPED 011 PRMITED u.s.c. f t3te. IMr'dr• yN,r rne.r wluE.e ,Rrr AtcAge Rn.•,i ro if0,000
<br />eM ormuirwn Np.:m+rrr a/Mnr«n eeNNlAa Nwsyeral
<br />OFFICER OR AUTHORRED AGENT AREA
<br />COPE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lReArence e0 ettschments here)
<br />:55 E TUTAL IKON LI!!I7S HILL HE +iAZVtD, AND SETTLEABLE. SOLICS LIt+17 AFFLIFD FCn <=1UYH,2uiiE PPE:aY Y~NT-
<br />5hL bUHDEN OF PROOF fiE~1UIkEME'NTS UNDER I.A. 3. TDS CONITORING - I.P.3. OIL E GPFASE SEE I.PeI.(D)
<br />~O I)tY AVERAGE 75 V7GHFST MC}NTN1.Y IVF DICE 117fu Tq~^_ DYLTnA pF O/"CTGT_
<br />EPA Form 3320-7 108-95) Previous editions may be used. /REPLACES EPA FORM T-a0 WNICN MAY NOT BE USEO.1 0 0 0 9 O / 4 ~ I Z 11- 1 Or: G PAGE lOF Z
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