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PERMITTEE NAMEJADDRESS (Tnc(ude Facil/ry Nmrv/locarbn jfDifferenr)
<br />NAME
<br />FIO4Lt R?~'1'IPC'FS iINITh.D
<br />ADDRESS y 0 it I E K 7. ~ "'. f F F
<br />[r. Cl. !~r11 li .. ~
<br />FACILITY P AU G L A : 0 91 4 28
<br />LOCATION .
<br />UG4L:: CC A1429
<br />nTl';;: 4ILLZ'lh 3. ~v;vF ]!?• `IIVt. nG?
<br />NATIONAL POLLIffANTDISCRARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR;
<br />(2.16/ (A~ 9)
<br />r I
<br />P RMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM q n TO ~ ~
<br />(2(121) (22-23) (24251 (2&211 (2B~2B1 (3031)
<br />YIyOF
<br />~ - £ItiAL
<br />D•; 0° SA/tlZu°
<br />Forth Approved.
<br />OMB No. 2040-0004
<br />Approval expires OS3f-98
<br />' TA
<br />NOTEr: Read Ins ' dllons betor Lom IeUng this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Cab Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53 54-B1J 38-05) (48-53 (SC-61 F~( OF TYPE
<br />(3P-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /wa-YSIs
<br /> (6zm) 6468) 6570
<br />' ~ SAMPLE ?#~0..~ F.:kCrw .•••:trtrFr, ( 12)
<br /> MEASUREMENT
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<br />~LIDi, DOTAL SAMPLE +C+}#O[:': C'k:R~+k rROY~44 ( 19)
<br />P E N U E U MEASUREMENT
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<br />tiULIDS, ~ETTL(?A''+t.' SAMPLE --racF~ a~^':;:'x #eY-~c- ( 75)
<br /> MEASUREMENT
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<br />I HOH, TO'PRL SAMPLE v',"k:?4:: ^+kr :t ~ks C#*?i':e ^` { 19)
<br />(!S FB) MEASUREMENT
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<br />-IL AND 4RLA5` SAMPLE aa~a4^ #sacca ;r. •: i::k;, Y,:_~ ( 19)
<br />- MEASUREMENT
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<br />r.FFLUk:ttY GPDSS YA!.[I ,gEgUIREMENT ,`-~ y.~;r. ? +~+ w ,n -
<br />' Ow, IM CQNDtJIT "( SAMPLE ( D #Ofi##a ##C-#O4 '=#'.++k#b
<br />Iii tJ TkEATH i:4T ~I,AV MEASUREMENT
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<br />NAME(TITIF PRINCIPAL EXECIfTNE OFFICER I CEPTIFY UNDER PENALTY OF L
<br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSO
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<br />SIBLE FOR OBTAINING
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<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTING E THE SUBMITTED IN
<br />I AM AWARE THAT TH
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af! e(mchmenhs here)
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