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pERSI~fTTEE NAME/ADDRESS (11rN4 FrY
<br />NAME 90Y L:: RE-.:. .:
<br />ADDRESS }) O .R L L' 4 ] , ,!
<br />' P. u. a;1x , , 7
<br />PAJhLA
<br />FACILITY Fi 0 ~d l L " f 3.) i) ',:
<br />LOCATION
<br />17NaJ/aml,n 1/DlQfrnwr)
<br />~, .I~ 1. e'D
<br />CJ d112 ;
<br />'.i, LL -iICED
<br />ATTIiE Yf1. t.r L" a_ ~ eo u D /nbC ~sru
<br />NATIONAL POLLUTANT DIBCNMGE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONRORING REPORT (OMRI
<br />l1-161 17-I91
<br />n ~ t
<br />^ PERMIT NUMBER DIBCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM y y nI D TO y
<br />/]6711 I77-T31 /74751 176-DI /78-79/ !36311
<br />Forth Approvqepd.
<br />POVD R DSCHG TO F°~~IJ a~".~{kja
<br />ve lcprted'
<br />(S!)D.R i1C) 12345
<br />r - FI rtAL
<br />!IN^;,
<br />NOTE: ss nstructlons •{or pMtinp this form.
<br />PARAMETER 13 Urd Onlyl QUANTITY OR LOADING !I Grd On/yl QUANTITY OR CONCENTRATION ND FREOUENCV SAMPLE
<br /> !<G531 !54611 138-s51 !46531 1546/ OF
<br />137-371 EX MALrss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-s.T1 !54681 !69.701
<br />PN SAMPLE #:kk##: C###?~ ..>•:= #y ( 12)
<br /> MEASUREMENT
<br />OU4J~ 1 U U PERMIT #r;e??~ #?:k#?? ### 5.5 #~## ~ 9.0 ESXLY N5IT'
<br />'~ F U c'i P ;; i'. 7 ,i 5 V REQUIREMENT .
<br />'^ Iv, i 1:.AL
<br />` SAMPLE #?0?#R ?3C##d #??#SF# ( 19)
<br />iPEND ;; MEASUREMENT
<br />
<br />U053U 1 0
<br />~
<br />PERMIT:,:::
<br />.<r ,.
<br />araaaaa ,.aam#?? ~~z# #a.~?a~x
<br />
<br />
<br />~ 35
<br />
<br />
<br />~ 7Q !ICE/ :$#9 <:
<br />F F L' M - .R.EQUIREINEI~lT. ~
<br />r 1 .
<br />SOLLDS, SETTL~ABLa SAMPLE r, ,,',;x #:F:.;:~.H #Gr##~ ( 2i)
<br /> MEASUREMENT
<br />~/,~'~45 I ~ ~~" PERMIT #; C:#k~ da#?r`91 r~~`~.`- ?##?S:r HEPO T O,S NCE/ iRAR
<br />:.Fl•'LUENT G8045 VL ~ REQUIREMENT y..#: H• M N
<br />1i{JN, TOTAL SAMPLE ;; ;.-~;; :Y:-?#G ,F#2:;~:p ( 19)
<br />(A.i PF,1 MEASUREMENT
<br />,~L(J45 L 0 D ~ PERMIT :=?#R_.:# #?$C#:x OEI# ~?~C#?#': -j,J 6.0 qCP/ iRA®
<br />;; F F L U E N T GR O S S Y U 'AEOUIREMENT
<br />~ « r n r
<br />. r~ H
<br />JiL AND ~iiEASE SAMPLE ~:##;: •,r ?##Oi# #x##;:;~ :,, :: :' (
<br />1 g)
<br /> MEASUREMENT
<br />U3S:iG L U U PERMIT. #+xa~x# ??xo?? #.:-.: akrir#m #~:,•:>~ # ID. ONTIN •RAR
<br />EFFLUENT GROSS YLLUL REQUIREMENT ~r### M -
<br />
<br />fLJY, IX CONDJIP UR SAMPLE
<br />( 031
<br />#.p;t#;:
<br />#:-'t
<br />r;c~:
<br />•'U TREATNEN!' LAg MEASUREMENT
<br />SUOSO 1 0 J PERMIT' REFJ'{i REPORP ##$#:= I/ ./? :~ ###r#+~ .': EL'6LY CIV51'AY
<br />EFFLUENT .;R~F~ YALU :REQUIREMENT 30U$ AY3 ~1X n U r '*.=as
<br />SOLIDS, TOTAL SAMPLE ~##xr# #.x#;#:: I 1 ar:>:rr,- { 19)
<br />UI550LYGD MEASUREMENT J
<br />l/
<br />7UL95 1 0 ., PERMIT ##?p## ##?c~a# rx'x;• #~ic??Y dEl'0 T .OPTIONAL THL[ iRA9
<br />EFFLUENT .:RUiS YALUi: REQUIREMENT ~,~# Y „~
<br />NAME/TITLE PRINC~AL EXECUTIVE OFFICER I eERnFV uNDeR PENN.Tr of tww THAT I HAVE PebsoNULV El(AMINED MD TELEPHONE DATE
<br /> AM FAMIUM WITH THE INFORMATION BUBMITTFD HEREIN: MD BASED ON
<br />,~ /
<br />~,V I L L //7 /)7 f ~ ~j t 11 !' Il MY INQUIRY OF THOBE INDIVIOUAL9 IMMEDIATELY REBPONSIBLE FOR
<br /> OBTNNING THE INFORMATION, I BELIEVE THE BUBMITTED INFORMATION 18
<br />TRUE
<br />ACCURATE MD COMP
<br />AF
<br />I AM AWME THAT THERE ME J
<br />'
<br /> ,
<br />L
<br />.
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING /~Y ~~ /
<br />~)
<br />U///A-~. ~ f ,
<br />THE POSSIBILITY OF FINE MO IMPRISONMENT. SEE to U.B.C. E 1001 MD 83
<br />SIGNATURE OF PIIINCIPAL E%ECUTIVE L? ~f ~,~ $? ~~j (~ ~/ ~'
<br /> U.B.C. f 1Jte. lRnMlu„ uHr rMr. mvn, ro.E AxA.W r,w, ~ ro s 10,000 AREA
<br />TYPED OR PRINTED .nsa~n...t+wnwrwiaanlFnraan.«nsmanrn. «dsr.ra/ OFFICER Op AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANr v1ULA I IONS Iltsnrmn en srtscnmsna nsre/
<br />aETTLEABLE ~]LLn~ LI`1I7 ADaLIES 09LY Ir := 10-YR, 24-NR 2k;.;;LH tYtNT LS CLAI"+ED. IF CLAIh IS .{ppRCVSD
<br />~Y YaCD, T`; ~ CkJV LC1LT5 BILL N]f 8E APPLIED TO 9F.PDRfED .iEAaUNcr.L•'NTS -SEF, T.9.1A, PG ` A90 I. P.1!', P,;.
<br />Fwm 2 = (B95f PI'sviolis editio a rtley used. ~ 1 EPLACEa EPA FORM T-0O WHICH MAY NOT BE USED.1 PAGE OF
<br />0473/970814-1535 1
<br />
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