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PERMITTEE NAME/ADDRESS rLrVbFxYIryNaWLoc,1141 r/orp....9 <br />NAME (=Y?: {).. vs.Dd Yal. i."( ""1nL ~7:~1`. <br />ADDRESS ° T Ir ' + • ~ ~ ) ~ n"'°:'. ° ~ r '1 A " ~, <br />•:CI:1. ~:~^. ^-Il ~'1L-i5 <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM INPDESI Form Approved. <br />DISCHARGE MONITORING REPORT (OMRI <br />lRf61 p7-f91 "- ~"' A " n mn OMB-Np: 2040-0004 <br />'. U O I ~ 7 L; q (` D'1 A I _ ^ ^ ~ L, +' APProv e~{li~es 05-31-98 <br />PERMIT NUMBER DISCHMGE NUMBER _ ~ - ', T <br />~...-. <br />MONITORING PERIOD ' <br />YEAR MO DAY YEAR MO DAY <br />FROM r _. /. TO ~. ~ _... .., -.:..,.~ ,-._ -[ ,_.. .. <br />IaPafl !2a-a31 /a4a51 la6all ras-a91 13a3n NOTE; Reed Inetructlone be1u; complstinp this form. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !~ Grd On/y! QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> !46531 /5A-61/ 138-451 !4653 15i-6fl OF <br />l32-371 EX ANALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsa-s3~ I61-sBl l59-701 <br />F:iN SAMPLE {~^~+~G :: ~ ':hY: v~ .r.._+..~,. ,~ <br />2~ <br />G <br />r' <br />GJ~ 1'11 ~~ 3~t7) /.lul lei <br />r~rAL ',.':Y-u•,,[^ MEASUREMENT . . <br />7'.79!'0 ': 7 PERMIT #;::A~J;: <br />., <br />Ss ;s#?:~•'.~ <br />, <br />.. Xekf:Y,e~:s!: ~ .~ <br />• ~-,*r)„,. y.4R.FJ tAr <br />EFFI,U]\T '47°Si VAL'!'•, REQUIREMENT rt' <br />?e ~r)np ac+r; "R'. Tb' ':` '""'/T. M. kT? <br />SiLYF;,!, .,,}"FNTTALL? SAMPLE ;: ;; ,t ;:?c{: 0:rrfCC'.: -t~•~?:':.• { f ^t <br />' 1 <br />9I557LY :G MEASUREMENT ~ O,O DOFJ ~n. o``Q C, ~ /9SI ~~~16 <br /> <br />%1104 U U PERMIT o~asm~ axaalaa '-'s kL`;;-,r:~r. <br />'FFLUE'I_ ',!'DSS Y4J,'c REQUIREMENT ~ae?Y grl~e 1v-• ~~*Lv **;~ ^/[ q,~w+i'a <br />_I? E8, :'^.TF'Nt'T1<LLY SAMPLE rJrh3G '."t~G;-: <br />~ <br />OOI <br />O <br />U <br />[~~i~ <br />{ ~" ~ <br />1' <br />~~~~ <br />t{7~•[S7 <br />~ <br />7-;tiJLY{ t MEASUREMENT . . - <br />S14U6 '1 ~ PERMIT 17::$;,. ;sr +,:; r,.r.^:t ,. t!c!k:tt:k (1. n7 "? i.?' <br />. VY7 <br />N,. / r. <br />ft , <br />!.FFLUi:: ~ -'• 15` Yr1L!IP REQUIREMENT ~G 3~l1A. fr- r.f_TrY .y "1?. Y;1HT%r <br />1AA :A:i ~. ~'~r^")n t. [. SAMPLE .. ...., [: {:.:ro-~. tv YrA:`:°-^: ~ <br />LLJ ~ <br />7~ ~ 1~ ~ ~~~~ ~i~i~~ <br />i E:. v Y ~ i'rl - L `. MEASUREMENT . . <br />IL 7-13 i Cn i PERMIT ^?: k^!»r,; .-~:°.x:Tt ......~;~+..! .7 .. ^. r.T~^• ~...n.-r <br />' <br />iFFLUF. ^: 'I ,` 75 Y7Ln' REQUIREMENT -,;,4 37~? 17^ n1"IF <br />"Y ;/?. <br />?LGN~ I`: C.^`!{•rIi ~^ <br />' SAMPLE `~,'•-1"~ <br />-~-gTT ~i <br />u~~Fi ( 731 .... ~ ., .. L ~J~?71 IN~I{~I~i <br />rr.au ?4Y.a <br />t°°"° k'I,~S'r MEASUREMENT - <br />O I %6 . <br />)OOSD S U '1 PERMIT. <br />' PEPJHT REP:IZT `#'-",:~^' `"'"' •. ",#:.`~: ;: - <br />,-. 1 Ir%^{t j,Y _f<'S ~'',,• <br />PPLDBN'P .i2J,5 yALUc REQUIREMENT j,QD.A AIG DAIL[ i1Y MC9 ,~ ~: •;: <br />}Iv AMD ~ik GAi? SAMPLE i+t 'r++'-~ ~ ~ ~N) lria tf;:1:-:: , <br />~ <br />I S U A L MEASUREMENT Q Fr ~ ~ JIS[fQL <br />44056 1 D U PERMIT 4fi'ki;%C } p E~=1 :~g>saa :t:x~::;-A;; :. r:>;~.yrf: .. ~ r:vLv ,T~1~r,T <br />~FF;,UF.N`L ,7R~~S 'v?LU% REQUIREMENT INyi ryA1T `io-0 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ~ FTilu ~ilui nDwI7H TH¢ INFO nMATIONTSUBMIITPEDS EREINrAND BIASED ~ <br />- TELEPHONE DATE <br /> ON . ~ <br />r <br /> <br />Rlch:' r :AiII~. MY INQUIRY OF THOSE INDIVIDUALS IMM WIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS <br />~ / <br />1 <br />'` TRUE. ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ME ~ <br />~ <br />/ ~~ <br />~ <br />?IIi:C ~r <br />[][1y7rQ'1 P19 F1XiA~ I SIONIFILANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING L, <br />~„ <br />_ <br /> <br />'~f <br />THE POSSIBILITY OF RNE AND IMPRISONMENT <br />SEE re U <br />S <br />1 1001 AND <br />C 970 ~ rn-z-/$J ) 00 L1 f1 <br /> . <br />. <br />. <br />. <br />3a 610NATURE OF PR <br /> <br />u.s.e. f rare. rr.ww. Mw n.s mnm„e.r xTlw, n,., to ro Fro.ooo INCIPAL EXECUTNE <br />TYPED OR PRINTED we.,~ti..,,:r,A.:anr,rae.n....smd,rn,wsr..+.l OFFICER OR AIftHOR12ED A0EN7 CppE NUMBER YEAR MO DAV <br /> <br />GuMM[N IS Anu cnr~nlrw I Ivn yr nlr T vwLn I wlra rrrnerencs ar ertecnmenrs nere/ <br />A:.':{?S"II- LIvI.._ ~,,: ..i'i ,~..rL'17'.5 G'7LT_`13 (L~~C tiE) .AT^ry riT-v Jr: C. ,n_ - ~ _-. r,T. i <br />il,i "'L. - I -, F' IHr fl ~0 '1 1 7 PG7 p ] ~^NCy ,.rte r1.T -, .-. ., -__ -r,n-. .. ,~.. o/ ~~ <br />r <br />EPA Form 3320-7 108-951 Previous editions mey bs used. (REPLACES EPA FORM T40 WMICM MAY NOT BE USED.) „ ~ „ ~ / ., ,. -~ _ ., „ i PAGE ~ Of <br />