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PERMITTEE NAME/ADDRESSp YLFxrlrry;v~r,acurw r/Orpinnr)
<br />NAME ~Y .,)r 'a^PP •- -- - ,
<br />ADDRESS t:..`r. ,.. IF 2'~j rilF o'(-K'.a!I et
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<br />FACILITY
<br />LOGTION
<br />4T":. "'FI5 W• KL'';7,.lr '~vu1L RTy'I
<br />NATIONK POLIUTMT DISCNMGE ELIMINATION SYSTEM lNPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />1-161 (l7-/91
<br />7n72 (1~'~ 11u A
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAy
<br />FROM ~! 1 TO `"" ! !~
<br />!14711 111-131 174151 116-771 178-191 !34311
<br />Form Approved.
<br />•. '•,IC T r -,, .. ~- T~Of~B1No:.2040-000,4,..
<br />(^ ,; n n A V) APDrovel elrp~res OS-31-98
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<br />NOTE: Raed Imtructione belore mpktlnp thle form.
<br />PARAMETER !3 Grd Only/ QUANTITY OR LOADING !I Grd Onlyl GUANTITY OR CONCENTRATION NU FREQUENCY SAMPLE
<br /> !46-531 154611 136-<51 !46-53 !54611 EX YPE
<br />137-371 µALY95 T
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-6J! 16q-661 !63701
<br />~0~~",UC.ir'TY SAMPLE '?.riG# .~?;+X':`: ,,...'.:r,": ('I)
<br /> MEASUREMENT
<br />10113-~ _ '1 J PERMIT tM'~.~~# -'.:##xt:=k ;:ri: XY-k~t:'r~ nEp~~v'f ~ P"'T C„RL " M'i C~/ ~~' -T?LT ;}tR9
<br />:.FP'.UL' G7liS YRL'u^ REQUIREMENT r'Y.^-d ;T [}T~ tY^ ''TP eAX
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<br /> MEASUREMENT
<br />0U4'UU 1 U 7 PERMIT fi0G 2,tr0 ":au¢#;`- gY;t 6,5 #$r•~~# ?,n FER Lf. ;$AA
<br />:YFLIIr:','P G!iJ,S '1aLr!L REQUIREMENT ib#'FR *IYT!'tiM MI{ytMi1M ^^
<br />;'1LID5a 'TOTR'. SAMPLE .. . ... r^-? ~?. .. .... ~ ' OI
<br />:~'.J :, `' ° M D f. D MEASUREMENT
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<br />~~i;.IDS, TOTAL SAMPLE ~:::':4Gr? r.,`~.`•#01 ::'r#•:.~:`. ~ ?01
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<br />` MEASUREMENT
<br />I)`,1D 1 D 0 PERMIT .'.'tk ¢h0. .•.:F-'.`•::~.`• rk #si!'r!..... lr, 7n +•"_•F/ :~t.R
<br />. }': LU F. 7.T BH~$S lp.LlJ~ REQUIREMENT ri.XR ~ 3nnR !1xr T!pT v '"' " '"~
<br />;LLIO.i~ S 'fTf._°".~+L'. SAMPLE {a=?RG;c r,-:k X;:~;< ~.Arr ,: ~ -)
<br /> MEASUREMENT
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<br />Ji5•+5 J C .. PERMIT 'F'Y¢S,"ir tt;: }f,k'~+= ' :s := r='tfi*.•~# 7^U'1~1?T ~:x."S ~ ~C/ DtR
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<br /> MEASUREMENT
<br />!L~~15 1 !I :) PERMIT '~FR~??r~ #R-F LLOrR ts arik kri~!t'-k ~^~!.)P~ ~>: PC~R^' t K.','/ ^..19
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<br />FIfcON EY:@-^7aY vcTp MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENKTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON
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<br />`~ MY INQUIRY OF THOSE INDIVIDUK9 IMMEDIATELY RESPONSIBLE FOR
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<br />I BELIEVE THE SUBMITTED INFORMATION IS
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<br />SIGNIFCMT PENKTIES FOR SUBMITTING FKSE INFORMATION
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<br />THE POSSIBILITY OF RNE µD IMPRISONMENT. SEE 18 U.S.C. f ,00, µD Ga
<br />SIONATUflE OF PRINCIPAL EXECUTIVE a
<br /> U.S.C. 1 1310. IHVWeY. ,t,Ww fMr+ mrons nNY iFM1b r.\rs y ro a IO,000
<br />TYPED OR PRINTED rwa-munlun anMonN+lr orbnvwn emanTaAM6y.vs/ OFRCER OR AUTHOflIZED AGENT CODE NUMBER YEAR MO DAy
<br />COMMENTS AND EXPLANATION OF ANY vloLAl IONS lReterence e// ettscnments here/
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<br />EPA Form 3320-1 108.961 Prevlaue edltlone mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) nn ~r ~ ~,~ q CII ~' -1 ~ .~ ,) PAGE ~ OF
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