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PERMITTEE NAME/ADDRESS rr,.d,s. FsB,ryN~/L«.nw UO/d..wq <br />NAME I'ERii.Jk C~tEE'd .:]".~1HY <br />ADDRessTERR06 REEK LOAD-JUT <br />1Ar30 HIGRIi0.T 133 <br />PIONIA ;,0 31423 <br />FAauTv <br />LOCATION <br />ATTN: KELLY FRITZLf.R, JPENRTIONS ".;R <br />NATIONAL POLLUTMT DI]CHMGE ELIMINATION SYSTEM lNPDESI Form Approved. <br />DISCHARGE MONITORING REPORT lOMR1 - .. ~ ~ O 2040 O - <br />?-rer n-1s1 ) ^.. •~ MgrM.w, t,-P4 !4o h <br />CJGUSUU29 ~ ~=SJH3 aC) Approveie~~l~SoS-3E-sa <br />PERMIT NUMBER DISCHMGE NUMBER p _ FINAL 1G <br />MONITORING PERfOD <br />YEAR ~'MO DAY YEAR MO DAY <br />FROM TO <br />IZP111 I I?4-?5I !26271 !?8-?sl /36311 <br />MIi10R <br />•v$ !10 DISCHARGE ~~~ $''+`r <br />NOTE: Rssd instruetiom bslore eomplstinR this form. <br />" PARAMETER l36rd OnlYl QUANTITY OR-LOADING'" Ie Grd OnlY1 "QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> 116531 /54811 138-I51 !46531 !5451/ EX <br />/31-371 MALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Isz-sal 184-881 /69-70I <br />L AND Gii F.ASE SAMPLE $C$$$$ ~ 9'I) $31k##O #$4 ${r ~~-++ <br />I S U A L MEASUREMENT <br /> <br />4Ub U U <br />PERMIT <br />$#4~!i¢ ... <br />-:.:$;p"OR'I I <br />ES=1 .. <br />$pPi1~#``:::. <br />:.:,,:.AIO#~-.4 <br />#~.M,~~ ~ <br /> <br />A. <br />.. <br />F.°RLY <br />ISUAL <br />'FFLUENT :;R7S5 VALUE f{EnUIREMENT ~ CNST .![AZ . 110=0 " ,. <br />"' - #r:R- <br /> SAMPLE <br /> MEASUREMENT <br /> .....PERMIT ~:. ~ ... .. ..:. ::' :.:::. <br /> REQUIREMENT <br />" •. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />" <br /> "REQUIREMENT .. ~ ""~ <br />" ti.".".. .~: <br /> SAMPLE <br /> MEASUREMENT .. <br /> .PERMIT <br /> REQUIREMENT <br />:. .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT""~ <br />~ <br />" REOUIREMENT~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> 'REQUIREMENT ~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ <br />~ <br />" ". <br />. ~ " <br /> ~IiEOCJIREMENT. :... <br />... ... <br />. ,. .". ~.. . <br />NAMERFFLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIM WITH THE INFO UW THAT I HAVE PERSONALLY EXAMINED MD <br />RMATION SUBMITTED HEREIN <br />MD BASED ON TELEPHONE DATE <br /> ; <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />~ <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS / <br />--~ . <br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIRCMT PENAlTIE9 FOR SUBMITTING FALSE INFORMATION <br />INCIUOING , <br /> <br />Y,e 1 1 Y Fritz 1 e r ~i~,-. r Mn • , <br />THE POSSIBILITY OF NNF MD IMPI1150NMFNT. SEE 1B U.S.C. 1 1001 MD 3] <br />~ -~ <br />IO <br />'bpI <br />E <br />T <br />E <br />~7O p <br />~L - P <br />D I <br />~ n <br />= I'I <br />TYPED ORIDRINTED U.S.C. f 1 ]te. lAVWeYF I.Nw IMw Fdnma mFV NrAW hws W ro i IO,OOD <br />rls wn.,n:ruwr inplwwnrNwMnrwn enw~N~ W e vAVA! B <br />N^ <br />H <br />NCIPAL EXECU <br />IV <br />OFFlCER OR AIIfHORIZED AGENT CODE NUMaER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRs/srsnce el/ sttechments here! ~ ' <br />SETTLEABLE 57LID5 LIMIP RPPLIi:S OILY Ii C= 13-Y?t, 24-iIR ?RE.:ab aYENT I3 CLAIfS2D. IF CLAIR APPflOYiiD PY <br />NQCD, TSS °. IRON LI1IT3 BILL NOT di APPLIED TD REPORT~.D 9Ea.iUdai:ENTS--S B IeB.lA, PG 5 AND I.B.1D, P~ 6. <br />STORK YlTP4 Ml Ya7F.NY RP ur aN f)Ilp 1-1 _Od- ~ <br />EPA Fwm 3320-i 109.95) Previous editionB mey be used. IREPLACEa EPA FORM T40 WHICH MAY NOT BE USED.! O1 3 U / 9 7 :J 31 9-125 4 PAGE Z OF <br />~- <br />.. t-.i , Lis4 <br />