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PERMITTEE NAME/ADDRESS pneL:dr FSlhyNwJfaa,a VD,~Irr..rJ
<br />NAME Cv , ~U vE Npq V>:-LL:"Y ":?AL ~:?'•/.
<br />ADDRESS '.71 ~: `.•., tr-.,j -~r?Limf`A ', ~;~I(M 6, L' ^%
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNAROE ELIMINATON SYSTEM INPOE$) Form Approved.
<br />DISCHARGE MONITORING REPORT /OMRJ
<br />17461 I7-191 "` ~ ~ F ^`?Nrt ;~ +~r?OM&Nog2040-00041: ,
<br />J (~ -17 71 i rJ r? ~ ,^. D - f c APProve axPima.05-31.98
<br />PERMIT NUMBER DISCHARGE NUMBER ^ T v ~ T
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<br />MONITORING PERIOD "
<br />YEAR MO DAV YEAR MO DAY ~,~
<br />FROM .. , ~ . ". - TO f'-' .. ~- ~;:. „ ~ . r -.'- ~ f 7'; v (~ ~. +: ~.:':
<br />!767/1 l11-231 17475) !76771 l1b-191 !3437/ NOTE: Raed Inetruetiorr before completlnp thb form.
<br />PARAMETER !3 Grd On/Yl QUANTRY OR LOADING !~ Grd OnlYl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46531 !545/1 l38-651 !4653/ /5461!
<br />EX OF
<br />131-371 ANALVSts TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !61.691 /64681 169-701
<br />" ,:e f1UCi IY_T"." SAMPLE +`:: ~!f k'e ("S.^h-¢h / ~I`
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<br />J1J54, "L (! PERMIT rF{:tY'k» '=RCR3F K:':.Y »r#'rk't ^FD!?^7 ~._. NCF/ ;PA i
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<br />?0556 1 D '1 PERMIT #;-RiL$ II9c#Qtth CS:: ?rX;t':#p' +:.: ~:t Ya;Y i!' !1NTIN :RA9
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<br />i~~)5D 1 /J D PERMIT R°P?RT ~PTiONAL »«i*~Ytsr, JCL##>xf: x~:r,.-!:wr „.A~ r~.LY rjr, •~ .
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<br />!4066 L 1.' J PERMIT '~` L•c J' I R5=1 ~ -Y:••; r, ya:: •V.'Jf Ytw R:~X'Y:^v .. FFkI.Y ' ISIIR',
<br />6FFLUF.NT ~'JSS YAL'J 'e REQUIREMENT INS* 9AX NO=U `fit:
<br />NAMERITIE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF L
<br />AM FAMILIM WITH THE INFO AW TNAT I NAVE PERSONALLY EXAMINED AND
<br />RMATION SUBMITTED HEREIN; AND BASED ON
<br />I TELEPHONE DATE
<br />
<br />Richard A41~~$ MY INQUIRY OF THOSE INDIVIDUAl4 IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION
<br />I BEDEVE THE SUBMITTED INFORMATION Is
<br />_
<br />environmental Manager ,
<br />TRUF, ACCUMTE AND COM0.ETE. I AM AWARE THAT THERE ME
<br />SIGNIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br /> ,
<br />THE POSSIBILITY OF RNE ANO IMPIIISONMENT. SEE 78 U.S.C. f 1001 AND ]]
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<br />EPA Form 3320-1 (08.951 PreNOUe edltlone may bs used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED./ ~ ~ ~ ~ _ / r r ~ - n PAGE 1 OF
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