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PERMI7TEE NAME/ADDRESS (/IrYdr Frmry Na.//,or,ua I7DIC.mq <br />NAME CY °:iJS Y1 'nF i~j. ;.P°. __ !. ~"1~-. <br />ADDRESS ~ 111 ~ 5 i t ~ - - F - r ~ ~ . <br />EN ~LEµ`.»~ C7 .I^7.55 <br />FACILITY <br />LOCATION <br />"Z`~: MORRIS Y. y."IF"(, :, ~.~1L ATNT <br />NATIONAL POLLUTMT DISCNMOE EDMINATION SYSTEM INPOE$l <br />DISCHARGE MONITORING REPORT IOMRI <br />r2-/61 !I7-!9l <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM r .. TO ' ' -/ ~ <br />r2o-2/1 na23~ (242si r262n r2a-2sl 1943/1 <br />••T 1 r'r. T <br />/P ~ • i, <br />- T Rr, <br />.., ,_. <br />Form Approved. <br />ApprovM e)C~ rya OS-31-98 <br />~ NOTE: Rssd Instruetlons bslors completing this form. <br />PARAMETER l3 Grd On/yl QUANTITY OR LOADING /I Grd Onlyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> 10653) 15467/ 38-45 /46-53 1546/ EX DF <br />(32-371 <br />MAiY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS lf2~sJ! /64.68/ !69701 <br />LI".1, 'f0~"0.L SAMPLE ...;:h'.`• rvx?•;,~ h.•,t•,.•..t ( Tq) <br />(0.9 P[) MEASUREMENT <br />J1C-t5 .~ 7 7 PERMIT .•: 't'c':# ;: r:k C;`.'= r=4 <br />r AictT'{aek.. 'NCO <br />t. P.R. 'TDT <br />4e r. <br />x~t:1 <br />:8A <br />~F:~ rr)~•.I ~, ~eTS a.`.•(.nir REQUIREMENT 4C`k ~7.':7n 1Y!; ns~T I+/ MY +e (;/L K.ryt, T+t <br />i t{il;., "'7^, A,L SAMPLE {:«:r; .k{e trek tp .`•¢ ir`O'k0# <br />~ <br />( 1~~ <br />(rt,~ ,t^F•) MEASUREMENT <br />JIU4S ~. C U PERMIT ~k~~Ll„;x rfi038# O ~c::k ?ff:3#+hR . 1,5 7,p ( !H.C°/ ~RA? <br />'FFLU' .I2 ;iS YAL!!° REQUIREMENT ;~k'tr iODA AYG DAi v n% R..^/L :"O'1^`~ <br />~'.r.J'•1, I:. C(1':pUT" ~lr SAMPLE ( ~3) :-k.;~:.. :}f,•~•~•••c• <br />A~ <br />#~. <br />IY917 TH}?0.Z"I:N" rl: ': MEASUREMENT <br /> <br />7 J.!`~J U d <br />~. PERMIT <br />ggpagT ~PrlaleAt <br />+` <br />::~x:k•z.. r.-t:~.;,,.; w:».~,, ; _,.: <br />.. t ar,•::'; <br />y ~r;^a•a <br />''G'LUr'~I+T GRrJSti y4Lf7 REQUIREMENT 30DA AYG !?!1IL4 l9~X, !{G9 , <br />~L:. AND .;kEA3 SAMPLE r: trY. ( 91) ,.. ?I :, - <br />i I S IS A L MEASUREMENT <br />~!4VSi 1 D 0 PERMIT ;-~x:l Ar O!~:~.:~. ) Y ~Sc! `='G?d:': ;::k •'::t .•: r. +r:. <br />`, F'FLUENT GRa S59YR L"t REQUIREMENT ~~ •.' I>[Sr qqy yn:D ~ ;-~, •.-; } <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD <br />AM FAMILIM WITH THE INFORMATION SVBMITTED HEREIN <br />MD BASED OM TELEPHONE DATE <br />,)I <br />!'ichorr~ rli I:I ; <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY gESPON4BlE FOq <br />OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS / ~ ,+ <br />t <br />c nnr~r <br />~' <br />"~Vf r <br />S9 <br />i ~ <br />:~ TRUE, ALCUMTE MD COMPLETE. I AM AWME THAT iNFRE ME <br />SIGNIFICMT PENALTIES FOR 6VBMITTING FALSE INFOMIATION <br />INCLUDING <br />~ '~ <br />~ j0 870-Z]~% <br />~ <br />7F <br />~~ <br />. <br />R, <br />~ <br />OnT <br />i , <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD ]3 <br />S <br />L <br />1 13te <br />IP <br />IMIM <br />uM <br />. d <br />V <br />Ae <br />f <br />O <br />+ _ <br />BIONATURE OF PRINCIPAL EXECUTNE _ <br />' <br /> <br />TYPED OA PRINTED . <br />. <br />. <br />, <br />. <br />N <br />A <br />~,.. mean, m,r <br />*c <br />, Fm+ w ro <br />IO, <br />OD <br />,.rwn~,rhnn inpioPnNtr erblwAm s,~nn, rasnA•,.1 <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />GVMMENTS AND EXPLANATION Oh ANY VIVLA I wrvs flre/e/sots a/ 6(Tlcnmenf9 Ms/6/ <br />.~i. ~~ [2M1r i.. L` .-S :'O„ rn•>i, r.(j = .T^Li'k =: '. :'T T.T~r (:. ~ r~r~ TY n••T: '- -Y' )11_:r^ t,oc.~r.~ <br />~:. 1~.'1 _... - rT,', 7A ~1'r J. `., '!1t. '1~(I?°\ 7° PI,T^c RclSI4°. .,P '•^-. 1TI, r• ~oRc-:._._v., nc'1'TT^, << ;•/ n,, ~ . <br />- / <br />~ 't r Y 'r f f • - fi n' -• R T•~ r ^• ~- t~ ~ T 'T V=. c 1 9 r v n~ v n/ <br />EPA Form 3320.7 108.95) Prevloue edluons+may be used. IREPIACES EPA FORM 7.40 WHICH MAY NOT BE USED.1 ~ (` ~ II F / ~ n D I I ~ .~ _ 1 / ,[ ,+ PAGE , OF <br />