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PERMITTEE NAME/ADDRESS (lneW4 FruryNar/InceNan /D~ir..q
<br />NAME TNA PdF;h KI!II++G, ia~.
<br />AGGRESS T R A F P F: ' ~ I ~' ~
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<br />LOCATION
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<br />NATIOMK POLLUTMTDISCHMOT~EMMINAiiyydM SYdTEM /NVDESI
<br />DISCHZ R6 E MONITORMI6 RW~ORT Y~9f
<br />CuDD32115 C N
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO
<br />176711 171-731 174-151 !16171 178-791 !36311
<br />Form Approves,
<br />morn ~: To MlGntraht~A7~'!Q~~ct;
<br />(v ll I? R ! N) Approvellexyrag~-05-31-98
<br />F - fIt~AL
<br />NTNCF
<br />NOTE: Read IrleWetlpu before completin0 this form.
<br />PARAMETER !3 Grd On1Yl QUANTITY OR LOADING !I Grd Ontyl QUANTITY OR CONCENTRATION NO, FREO~EHCr SAMPLE
<br /> 146531 1546E 138-461 !4663 154-8/ EX TYPE
<br />137-371 µKYyS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE 'MAXIMUM UNITS 167-6]I !64681 !69701
<br />h SAMPLE arises; 4riVlbri;t maa#•a ( Ij)
<br /> pEASUREMENT
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<br />:.L.iSOLYED MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ rA MILIAti wITMNTNE IINOFO RMATIONTSUBMITTEOSMEREINrMD IINISFD oN TELEPHONE DATE
<br /> MV INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR ~ /
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<br />W. WL1iVn PCtelti
<br />OeTNNING THE INFORMATION, I eEUEVE THE SUBMITTED INFORMATION IS
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<br />ACCl1MTE AND COM0.ETE
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<br />TIES FOR SUBMITiINO EKSE INFORMATION
<br />INCLUOINO
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<br />A 4401
<br />9]U 824 99 D1 2
<br />President 6 General Mena {=
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<br /> THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE to U.S.C. 1 1001 AND 7] ~ iIONATUIIE OF fhtINCNAL EXECUTIVE
<br /> U.S.C. S 111 a. lMrNLa udr e`w~ moms „IFY AcMI• rota Iq ro f 10,000
<br />TYPED OB PRMITED rlsweu..ErR•ni,prlaNSnnr we.r....ammrAaW 6Y•r•.l OFFICER OR AUTHORRED AGENT ~pDE NUMBER YEAR MO DAY
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRafarenea a!l atfechmanf] hsral -
<br />.:» G TOTAL INON LIMAS GILL bF. NAIYEJ, ANL SnT1'LEAEsLc iJLICS LI!:I'[ hFFLIFn FCF <=10YF,2UHu PP,dCIr -.VntfT-
<br />.;ii BURUEN OF PROOF HEIUL9EMERTS UNDER I.A.J. TDS !!ONITDPING - I.E.3. OIL E GfEASE - 52F= I.P.1.(D),
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<br />EPA Form 3320-1 ION-961 Previous editions mey ba used. (REPLACES EPA FORM T•40 WHICH MA NOT BE UeED.I 0 0 G 7 5 / 9 7 ] ,x,11-164 F, PAGE IOF 2
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