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PERMITTEE NAME/ADDRESS pd,~. f«wryNawr~«w, IJold..e,0 <br />NAME ThA.'r'C ~, J'.:' ~~, .'~C. <br />ADDRESS T' d q t' Y° i. ^' S '. P. <br />P.U, k ?: 7 '7 <br />C:.A.I ; ~ . _ .. I <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE EUMINATON SY6TEM INPDESI <br />DISCHARGE MONITORING REPORT IDMR) <br />(1-161 !t7-(91 <br />:.:f?~321 5 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM TO <br />11627/ /77-731 (1L751 176-771 l76-191 !363/1 <br /> <br />Fprm Approved. <br />ACUTE. r~.s T'?~TIyGGMRd''A•~4~'l-9°oa <br />(° L` ° F }. 4) Approvaltst(plreq.:06-31.98 <br />F ~ FT!~AL <br />• 7 N f„C. <br />NOTE: Reed Imtructlorr before complednp thu form. <br />PARAMETER !3 Card Only) QUANTITY OR LOADING /I Card On/yl QUANTITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br /> 146-53 /5b61 138-~51 /1653 (5L611 EX Ky TYPE <br />(37-37) µ <br />Dg <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (a7-ea) (6.-6H1 (s9-7o~ <br />L~~ ]I,1ItiF. 4UHR A!.; SAMPLE .:~:'n4C CtXGP#;F nd~i#Y-'.~ +!!„~',t;ts~ ~ `j~ / <br />:'~'RIOpAi'ri?!IA MEASUREMENT c <br />7/~jl O /d LLarp <br />;A't35 i (/ 0 PERMIT .:r.:>r:•40 ry01'-F#rFO CkG ~Qa <br />tPltO~:q: <br />fi'Or71FO%F <br />P.R- <br />TREY <br />wRgB <br />EFFLUENT i; N'}S VgL~1' REQUIREMENT . <br />NT <br /> <br />'..: <br /> <br />.. <br />LC~J STA Pfig 'lOfiR A':-` SAMPLE ;~y ~ '::::::: ^:fGOD91 COOAIRC ?t4+: tt^- ( 23) / <br />k'If;EFi1ALE~, MEASUREMENT ~/00~ <br />< /~ /~ ar9a <br /> <br />. A.IbC 1 C '0 <br />PERMIT <br />': s:~'3 ~:: <br /> <br />Y#A~#IRiP::. <br />~ <br /> <br />~>56 <br />...... ` <br />1h4:, <br />. <br />': <br />~ <br />: .. <br />.'..: A'E4 <br />: JEti1=J <br /> <br />`:+¢+169~~! <br /> <br />E5 <br /> <br />xkLT <br /> <br />:;A$=: <br />LFFLUEtiT G"r.'JSS YP LJ: REQUIREMENT +: :t j/(rfj .. <br />- <br />. <br />: <br />I,ly'K .' ':~ . "N <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~REOUIREMENT ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~~ ~ ~ ~ ~ ~ ~ ~~ <br />~ <br /> REQUIREMENT - ~~ <br />~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT: <br /> REQUIREMENT ~ - ~ ~ ' <br /> SAMPLE <br /> MEASUREMENT <br />' .PERMIT :.: <br />~ <br /> REQUIREMENT': :.' ~ ~ ~ ~~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 cennfr uNDrn PENUrr Of <br />AM fAMIUAfl W1TN THE INFO uw TNAT i NAVE PERSONALLY ExAMINED AND <br />RMATION SIIeMITTED HEREIN; AND 9ASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIpVALS IMMEDIATELY gESPON51elE FOR n <br />` <br />r- <br />11. GordolL Peters OSTNNING THE INFORMATON. I OELIEVE THE SU6MITTED INFORMATION IS <br />TRUE, ACCURATE AND COM0.ETE. I AM AWARE TNAT THERE ME ~/~ G ~[S <br />" <br />~ <br />PTe9ldent 6 General Ma 8$8T SIOMIFCANT PENAL71E5 FOR SUBMITTING FALSE INFORMATION, INCLUDING <br />THE POSABIUTV OF RNE AND IMPRISONMENT. SEE le U.S.C. E 1001 ANp ]] <br />iIONATURE OF MINCNAL E%ECUTNE 9]D 824-4401 99 _ 1 25 <br /> U.s.c. ! 1]ts. /ANrro..,AMr swr mnm. Arr i,cA.dA 6nrF w ro Sfopoo <br />OFFICEp OR AUTHORIZED AGENT <br />C <br />E <br />NUMBER - <br />YEAR <br />MO <br />DAV <br />TYPED OR PpMITED r,dw muYAlm YroACMrwn o/bwwnemanerA rNb wra/ UR <br />COMMENTS AND EAPLwnw I IOn Ur AnT vwLA I wno /Naerenn a/ emcnmmrs nsrq <br />. z.o 1. A.1, PP 7-9, pC4 lle.?APES CE' TEST PROCEDURE, fiF,PUkt LC~C - °T AT 1ST TCAL P^I'•T F5'II4ATf. 6. 'tICH I': <br />L.:'1'4AL TU 50%. O}' TEST URGANIS85, AND ATTA'at ACU'PE TOXfCIT.Y TEST RffCFT EOFY, TC C'~F. COPIPi; OF ALL <br />- T ~' /~ r 11 r <br />EPA Fwm 3920.1 108.961 Previous editions mey be used. - 1 LA 8 A FOR O W I A BE S D.I O C O 0 4/ ~ 9 C 11 j - 1 0 5 5 A 1 F ^ 1 <br />