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PERMITTEE NAME/ADDRESS pnaii6imtllry NAw/foc•u•n IJD~.mrp <br />NAME .;°. :r''Il~ +1!~t '(Sit^1 ^"'iL 'f+'r'• <br />ADDRESS.~'(:~.j Jr 1J (3 ~J11...pF ~ y^gMA.r ,lv <br />- g1JJ £+. .r •i":°L'0.L ~Ca^LF <br />:. ~L .:"•-~_ •-(: ',^,155 <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />l1-161 17- I9/ <br />'70'1?77 ,'L MS Y <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM Y' LJ TO °" L <br />l16II1 l11-131 114161 116-171 128-191 !3631/ <br />Form Approved. <br />r,~~7.•rP •. ~T ^;TTOMB No~2040-0' >,4 <br />F _ r, 'l ,r ° U 1 APProvel axP,irPs .r5-31-98 <br />.. Tr~^ <br />NOTE: Read Inetructlone before complstlnp this form. <br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING !4 Grd OnlYl QUANTITY OR CONCENTRATION NQ FgEOUENCV SAMPLE <br /> 146531 54-571 138-451 !4653 !54671 EX DF <br />/31-371 <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsl~sal !54591 159-701 <br />::Er Y°_° -L fi T'RF 1^AY SAMPLE `-C; ,;:.^,I ...;::;: IDO ~ -.. .-y:....;-.. ~ ~~J I <br />'I 1 I c <br />^ H n - T I} 4 ~ •{ .. r . MEASUREMENT <br />f <br />/~ ~ <br />!'~i'~•J .~ ;7 ,i PERMIT ;::t C: ,.tix »k....#,': .. IJ2 .': •r ..; ~. A.;-:. Y: ~'. I•. _ "!'ALY 'K <br />~.:' CO'.`.~ry"5 -P CT.OJ REQUIREMENT n:xrt rf Ky 9Rr.fT" '" <br />"."FPFC'r ~~^apar 7:+.1Y <br />' <br />' SAMPLE <br />MEASUREMENT .C Y'k ;:h ...-.... ~r <br />7 ;:;r.`:: ( ~~) ~ 1 ili l~CCl <br />=dR PI^!._ <br />•LF-5 <br />d !"IZ <br />"Cr:..C ., C ) PERMIT ##lk +k'k .Y #trGO;r~ <br />ry ;: {r,`. La7 „t:::: -;:.. .. h::::;::` - _ t .n•pT 7j -n cT•,r <br />i F, i' :, 0:"~~,?'S d'Lla REQUIREMENT 4-'.~.•3 et VALI?c r-:.. <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY uNDtR PENN.Tr of uw THAT I NAVE PERSONALLr FxAMINEO ANO TELEPHONE DATE <br /> AAI FA MILIM MTH THE INFORMATION SUBMITTED HEREIN; ANO BASED ON ~ <br />~' MY INOUIgY OF TNOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATON, I eELEVE THE SUBMITTED INFORMATION IS ^ ~ <br />~ ~~ <br />/ <br />/ <br />Icltard IVI~IIS TRUE. ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING i~ <br />1/ <br />G/I <br /> <br />EnvlrnnrTental ~.lanaeer , <br />THE POSSIBILITY OF RNE AND IMPRISONMENT <br />SEE IB U <br />S <br />C <br />11001 AND G] _ <br /> <br />~ <br />B7O <br />B7O-~7T~ <br />[ <br />iS <br />9~ <br /> . <br />. <br />. <br />. <br />! +7te <br />U <br />S <br />C <br />(FlnWa <br />M•r dws mom <br />A <br />I <br />NA <br />I <br />a <br />l <br />f 10 <br />000 SIONATURE OF PRINCIPAL EXECUFNE <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />• ur <br />s ,rr <br />Y <br />A <br />z <br />n <br />• <br />rm ro <br />, <br />And Ar nrArinMn inplANNwrr A/brr•rremnNa Ands yAVAI <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />L.VMMCrv 1, /VnM Cnrcnnn nvn yr nor vivcn nanw mvrorencv en Aruscnmsms nerp <br />.-iG° 'C• •-I F7? <br />J':Llye„I ).. ,- <br /> <br />~ '"S.iT PR1,_?D7~=• h'u" <br />+rmnyTCT:•'Yn. PpP '~ o5: ilL"' JF L.^z!:iLI iY 9>^ItiPnT'~`,- a,~ ay:. ..r-~u r,,-, .. <br />a?ST w .. ~ r Cur" w4 T r <br />4.F.L A -°~ 'i` TC'E 1.LY ^',r„rP ..T^.. , <br />"va~+pl;^••T^, I, <br />_ ~ rn !'DTI. <br />IC•1: TCr'1+ ^9!'= 4rN <br />D_ - Can w ^l4 •1!r r T ^l1 MMF -•rt~ _ <br />^ <br />EPA Form 3320.1 108.951 Previous sditione may be used. - (REPLACES EPA FORM T40 WHICH MAY NOT 8E USED.1 ,I ,~ T -. -r ~ r, r . - -. _ T PAGE n ~ O <br />~ <br /> <br />