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PERMITTEE NAME/ADDRESS (IMib FrWryNsWLxnrwr l(D+pawp <br />NAME _ v ,. - <br />ADDRESS °. C : - r i / - ., r, , r ~ - <br />,.L.. .L ~T'.. ~~ <br />FACILITY <br />LOCATION <br />;i.RaL A"1't <br />NATIONAL POLLUTMT DISCHMOE EDMINATIOM SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT lOMRI <br />17-161 117-191 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAY <br />FROM "~ t - TO ~ '' 4 "' <br />1147/1 l72-731 124251 /16171 l78-29/ 134311 <br />Form Approved. <br />. • - . - - - ~ ...OIdB.No. 2040-0004 - <br />t _ , ,~ „ ~ ~ , Approval expi~ a 05.31-98 <br />r -•r v. <br />• NOTE: Read inetruetions before complellnp thu form. <br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING I4 Grd On/Yl QUANTITY OR CONCENTRATION NO. FPEOUENCr SAMPLE <br /> /46531 l54-5/1 l38~61 146531 15b511 <br />EX OF <br />TYPE <br />l32-371 MAlrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs7-ssl !ee-6B1 159-701 <br /> SAMPLE <br />MEAS <br />T .-. ... r. ,. {: ::;:. q <br />~ .... <br />3 <br />g ~ "t <br />~ 5 <br />? <br />G CIZ~ <br /> UREMEN / 1 r j <br />., •i Jir 1 " PERMIT tvY .. ~..; ;t. :k'.X tkvRfi '.7 F.r - .°.::}. c n ~t Y ~?~q <br />. '~Lf!,{': •.' - ~/ aT U` REQUIREMENT .. MS gjntL' •.q!•TV pit <br />.. r~; <br />i.'!.I4ir ,, .i: AI. SAMPLE ~..... ;:a;:G:?': ..-. <br />N/ l <br />( •) <br />~ <br />~ <br />~/ <br />- .c.Nl: :.')'{q MEASUREMENT IV A A /N A <br />.,':S3J ) i PERMIT •~~~•~• :: ;: ••".::~~k^ C ?^`- :n;:140v ~r D(tu±' RF CCr P^` ( !i"t~/~ :C?.4n <br />~. f' ~J"'.'r ;; R'^, ''~ REQUIREMENT 30 lfj~M t7-' "!!'IT °.K r-rL wn.,.~R <br />:LjJ5r .'_%!'SL SAMPLE - -. ...... {,r:~t.....~ //, J ~ i:~~ <br />O <br />/ ~L <br />-VE';j ;l ~.J MEASUREMENT W [~ ~C 9ILRL7 <br />. r J J') i ~ ~ PERMIT ~ .`- t ... ... .~apa...° l'. " _ `~ :+, ry <br />. :'Lil?+L' G~~g- REQUIREMENT .. -r,~.. ., ~~... -Tw e•v '/T ~.... ... <br />{... L ~) 5 r : i' Y T L SAMPLE ~ - :' : C'.- .. - ~ ~ ( _ c 1 ~/ ~ <br /> <br />MEASUREMENT /f-~ A O A />"l <br />- I'. _ ,1 (' ~' PERMIT .. ^~7g rGi'. .. <br /> <br />~ .+~r: ~-.. o~ -. o^` ,- <br />~. <br />:'J' ' [: " "' r REQUIREMENT r..... .: 37'i n r, .r.. -, ~ 7 ..F ~ <br />i <br />. <br />.. . . <br />:.7 /.~;)jr ~ T.r 1. .' .. SAMPLE +~ ... ..... Y: ...: <br /><O <br />I <br />~ O <br />I / :i <br />~ <br />)/ <br />Z ~ <br />~ <br /> MEASUREMENT / r ~(~ I j I <br />J <br />;i.~ i 7 ' PERMIT v^$'X# .. .. ,^!-, :X'. ., 0~<-1" n. ~~ .^:Fm ..-r .. <br />r._'. i; 'r'. -7: :;h' .. i. "- REQUIREMENT ~ 1.7' A ~p -,tT'G '{ HX ". :./! ,I <br /> <br />... -, '/D :'~"~-~ <br />SAMPLE ,. .. ,. .. <br />.~. .-~.3~,`. ..gin,.. ..... <br />.. .- <br />-.`-'.:"::,': ',~ <br />., <br /> <br />~ <br />j7~ <br />( <br />r` <br /> <br />"' <br /> <br />L <br />, ~ i ~, c X m q _ ~:.: r ~ ~ ~ MEASUREMENT /A ~/ lr~ IA <br />I <br />IJ. ~ 1 '. PERMIT Y.':L=`•.. .v°C:.", .. YY:..,.r..~., t,-.^:r~.': n r -j~ ~ ,. <br />'')yp1: ~•~~~' 'r" REQUIREMENT ~:: T+'-- ++5, '! ^rr <br />t..• F .4; <br />' SAMPLE .. r:.[c .:~;. .. .. <br />"r „} <br />' V / '1 /~ N <br />/ ~~ <br />/ <br />( <br />, <br />; -' ) MEASUREMENT A A ~J ~ ice <br />_ , <br />-LL ~Ii .. ~ PERMIT $sp;: ;c :,: ;: r~{:r-nfi;. , ... nnT p.~- 7.-r .. i. <br />~,'~ ~7' "" REQUIREMENT .. 7^,nT tam r..-{v +ev ,-/. r.~y. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEMKTY OF <br />AAI FAMILIM WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED MD <br />RMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />~; rr,~ <br />Ilii r~l IhIII~ <br />I OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />TH <br />T THERE ME <br />.. <br />,. TRUE, ACCUMTE MD COMPLETE. I AM AWME <br />A <br />TIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />SIONIFICMT PENN _ <br />f' " <br />' <br />^ <br />' <br />- <br />~~^ <br />~: Cf• <br />_ <br />•rirunl <br />~r,rtr:, 'O <br />' , <br />. ~'/ / <br />- _ <br />'~ <br />'/ r <br />- ~ ` <br />, <br />, <br />_ <br />• THE POSSIBILITY OF RNE MDIMPRISONMENT. SEE IB U.S.C.f 1001 MD3] BIONATURE OF PRINCIPAL EXECUTIVE <br /> U.S.C. 1 t ate. IPerWOi. uOA- Mw mnm. ArY MrcNM rxwa w ro t 10,000 AREA <br />TYPED OR PRINTED .,.d armuhwninAn'>~.rIrNW6rnvrn smmFhaeMeywal OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Relerenee a//attachments here) <br />... ~ B ti `, ~ ( .., T ;. - ~ c F L ~ i ~ ~ <br />, <br />., ~ ., 'i i C ', ~, ' ~ 1 T. ) ~ ' ~ F 1 .. T. Y ~. T ~ (' _ y •, r - ? ~ - . ' r .. . <br />I~. .:6_C' .ir• ..'. r - !. `1r F,. '~!: "I <br />~ -7.:r 1'' 'I -.. ... ,.. ~ f. r - :' __ ~ ^/ o{• <br />F <br />• 11 y r ~ ~. L.. Tc .. .. r• ~.r.; ._ T.i <br />~ _ ~r~. ~. __,r~~n, ~.. p• - <br />n r <br />EPA Form 3320-7 108.951 editiona may be used, <br />Previous (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,~ , _ ., / ~ n „ ., ~ _ . ~ PAGE - OF <br />