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PERMI7TEE NAME/ADDRESS p.eHL frWryNaW(wwlu. f/D~p <br />NAME TI{APt'}.. "L'~ ~ ,'.r I6. .:. <br />ADDRESS T N A F e C? " I .~ <br />P.O. ,+;Y 1.7 <br />Cknl:~ CC t11b2b <br />FACILITY <br />LOCATION <br />nT in d. J0;'.G~~t• PE~!'E RSr I, f,$S/vEN .."„R <br />NATIONAL PGILUTANT DISCNMOE EDMINATION SYSTEM /NPDES/ <br />DISCHARGE MONITORING REPORT IOMRI <br />!1.161 17-791 <br />0000321 5 CO° A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM •' TO -. <br />!]D-Jil OJ-0JI IJ4J9 tlRJJI OA-J9) 130-J 11 <br />Form Approved. <br />CI SC HAFGE TO CCiYP~N4t,4E494DOOa <br />(S U P R K a) APProvd.leffpl~PLB505-31-98 <br />F - FIAAL <br />"7HCF. <br />NOTE: Reed Insttuctiorr bBSorB compMtMp thM Corm. <br />PARAMETER !3 Grd On1Yl QUANTITY OR LOADING !1 Ord Ontyl OUANTITY OR CONCENTRATION ND FREOUENGY SAMPLE <br /> l~6-53/ !51-61 l38-151 !16-53 151-6EI OF <br />l31-J7) EX Yps <br />ANN TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 111-eJ/ . <br />161-681 /65701 <br />vit, uh l~.' SAMPLE f. .'tl,4k ( 94) OOOdt~i' f}f;A9i}O Ct#O>,::s <br />'+ I v U A L MEASUREMENT f <br /> <br />d4J6f. 1 0 U ,".:: ; HMI7.. " <br />.. <br />:... " ' ~s #~~#: "t~ Ol;'? <br />L"Jx . ES=1 aDq.~.Sq .: " .4~>?~~0' .. A4A~?4+~ ~>a~ £EF:L YISUA <br />~F'f'LUE`IT i;H03S VALU .. <br />:::~4~1REAAENT: ..: ..:.:':: I.11S:~..:M'A1:. HO=0 j::.:E:.;=: .- .. ._. ..: ` ~YO~# .: <br /> ,; SAMPLE '- ~ ~ - <br /> bAEASUREMENT -~ <br />~ <br /> ..-. PERMIT: ;;;~~: <br /> <br /> <br />., r <br />: '": ,.... • ~.. ,.. ~; <br /> <br />z ... ,.. :. <br />: .. . <br />. <br />. <br />~ ....,.... <br />.:. <br />,..~ ~ .... <br />~ .. <br />u" <br /> <br /> <br /> <br />:. <br />;:: <br /> <br /> <br /> <br />:; <br /> . <br />E.... _ <br />. <br />. <br />.. <br />.... ~ .. <br />: .. <br />:,... ~: ;. <br /> SAMPLE <br />_ MEASUREMENT ~ ~jf y'SLG•G 1- ~ <br />,~ " <br />- PERMIT ' ~ <br />" '` "" "" "" " <br />y t{. REQUIREMENT ~ ~ ~ "~ fz. " <br /> SAMPLE <br /> MEASUREMENT ' <br />I <br /> PERMI T <br />" :..,. <br /> ;REQU.IREMENT :n ~': <br /> SAMPLE <br /> MEASUREMENT } <br /> ~. PERMIT ..' : . .:. ~... .. <br />" <br />" "" <br /> "REQUIREMENT' " <br /> SAMPLE <br /> MEASUREMENT " <br /> PERMIT ~ " <br /> REQUIREMENT ~ ~ ~ .. ~ " <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT <br /> REQUIR.EMENT~ ~' ~~ ~ ~ '~ ~ '~ ~ ~ " ~ '" <br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF l <br />AM FAMILIAR WITH THE INFOR AW THAT 1 NAVE PEfl50 <br />MATION SUBMITTED H NALLV E%M11NED ANO <br />EREIN <br />AND BASED ON TELEPHONE DATE <br /> <br /> <br />d ; <br />MY INOUIRV OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~/ / /. /~~ <br />fj J C <br />~j <br />on Petare <br />{~. Gor TRUE <br />ACCl1MTE AND COMPLETE. I AM AWARE THAT THERE ARE / <br /> , <br />SIGNIRCANT PENALTIES FOR 911HMITTING fKSE INFORMATION <br />INCLWING / <br />President b Gan~ral Reneger , <br />THE POSSIBILITY OF RNE NID IMP11150NMENT. SEE 1• U.S.G. 1 1001 AHD 3] <br />U <br />S <br />C <br />E 1315 <br />M <br />M <br />i <br />S <br />AA iIONATUIiE OF PRINCMAL EXECUTNE <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />Iw <br />. l <br />.. uldrr f/IIM Nnm <br />l0,000 <br />. ~sr Iq m <br />. /rf.Y Lf'f <br />.ndrnfrnwn N <br />/A>rlnlnr <br />/bMwrlm <br />tl <br />W 6 <br />/ <br />OFFICER OR AUT <br />R <br />C <br />E <br />NUMBER <br /> a <br />m <br />w <br />u <br />Y.rA HO <br />IZED AGENT OD YEAR MO DAY <br />GUMMCn I a nnv cnr ~nnn ~ wn yr n vrvcn ~ wow In.rerenc• or euscnm.nra' nqs/ <br />;)~ G DOTAL IdJN LIMITS aLLL 3° MAI7aJr ANU SeTTLEd°EL 5:1LIC~ L1111T AFFIIFO FCF <=l0YR.24F{9 PRE~IP f:YA.XT- <br />~)',u 6UHUtti OF PP.OUF P.EIUIRE MENTS UNOF.R I.A. 3. PEk lIITT°v HUNT TA%F AIL f;°ti50kAsLF: F1£AiUY,ES TO 4°.PUCF PF! <br />1 <br />)h4 <br />~~ <br />may De used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 0 U U U F, / 9 7 1211-1 b 4 6 PAGE ,OF <br />` z <br />