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PERMRTEE NAME/ADDRESS puY6frWryNr/Lxurm r/D~...np NAME I,V~;t!i$ Yj°PA 4ALL"Y ';15i. ..^a.'. ADDRESS ~ I ', i'i I , ~ i l S I^ ., T N' i t. ^'/{ % A ti .T C FACILITY LOCATION NATIONAL POLLUTANT DISCHMOE ELIMINATON SYSTEM INPOE$l DISCHARGE MONITORING REPORT IDMRI 1-161 l17-191 "?727154 '7?E ' PERMIT NUMBER DISCHMGE NUMBER MONITORING PERIOD YEAR MO DAV YEAR MO DAY FROM '!'t L TO "' T1 !1611/ l11-Z31 r1f-I5~ 1IB17/ /29-29/ !30.37/ (""" `''~ - T'1T ..r. Tr.. Form Approved. .r ^OMBI No.r 2040.0004 Approv e%pu s05-31-98 ~. ~'P- .... ,- r. .. - ~.... i ..-, .. ..NOTE: Reed Inetruetiau be1a~~ plating this form. PARAMETER 13 Grd On/y) QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE !46531 154611 139-<5l !0653 I5d-611 EX ' ~ 131-371 M L BIB TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 16Z-ssl 161-6B1 169-701 =J: °'I1Ci?'ICi'Y SAMPLE ~ +`•'`:" RR^-S: ': ~ .:':': ~=: ( ]1) MEASUREMENT 'I [`f.Q• -I r r: PERMIT (e(a; Ffcs :^n'tt;x fv .Ik! - ;<(rt +e r:±-~:et ne•nn r... c^. '.` r ,1n/ ~T.u~ v ^-Tfr t'PrL: ^' ,n 'i i 'J~i.'7^ REQUIREMENT spicy} rraax• tv^ . n'TmF .-gy .-~ P'1 SAMPLE :: t't.S+ ,.~~t; :..y :.. ( ~ 7) MEASUREMENT :)U4Ol? 1. U !7 PERMIT .r:F4C.'- ###### •-• 6.5 •4r~r•yT.`:.. -.'` t F.EKLv :9:E.i7 i:F"'L!': I: "'7 i~. Y!4'I REQUIREMENT TF# "C tirTMr~w ..av T'rnT r•I ~ iw I.I JS, ~~T"i. .A 11 L' SAMPLE ": L`: ~ „•G.^'-` 0et r: Trt ( i:~l r. MEASUREMENT JUJUy '' ~ '~ PERMIT L'h!: ;-t` r;t .-SSr: Z: .::,~ b:t zT;. y.; 9~: nn'.--r n-D~ nT r :, rs rC~.r ,r `. ;i ..i,t ,~ REQUIREMENT h-:t;r 'k T/l ix. q?r r! FI !fir ~Lv ~"1" '"T./C. ''1 :?N'1'V{ i LI'J:~~ .;a"TL°P"L'' SAMPLE ' ~p74C-:: .k'TCC#': t..:ynr. r,. :: ( ^5) MEASUREMENT )CS'!`] i C x PERMIT 7=:".;#?."t t:l:#R<,: i,: # {::;:T ?1!. M"~~b is ~I'P'Tnm . .. ~ ~ NC°/ [HAS i:FFLUk:';f .;N0;5 YAI f; `• REQUIREMENT jl.`2`A FY^ p.\CT.y *;X T*„/L {I•UNT!? JIL 0.`;U 3E°E`-F' SAMPLE ;.h 4`^-r^• ;a ;uY !: ': •:: .-. `•;r±: ( ~ ~3 FRr:7N :Y"d-;itAP 1E;TH MEASUREMENT :)Ob`.ib ~ '? 0 .'PERMIT S:P k$.~ ~: rf##Cr+t ht,: ;: kf'S<:fr!r i; :X•-w;•c :?; '' . n I., t ONTxN ~pA'! PFLUF."I' ^aNJ55 VAI Ug REQUIREMENT Yt:yO Tvr"' "AF °"/L :P.hT U W , I 'I ., N 011 L L D 4 SAMPLE ( J 3) ..:`'.`-'•`- - ,':':!:`•': ~:: t":I` ^ CII F±U TR ~.A Tt"PNP PLA•1 MEASUREMENT SUUS,U _ ^ U PERMIT HNP)4T )PTIONAL i##### =:fi^ar-~ .;. r;;}r<,t:: - •_.., ; ~ Fe!LY 'K~""." 'FFLUENP ;n7;`-: 'VAL'J° REQUIREMENT 3OOR AYG OAiLf *:'R nG0 .:.•.... )ir. ., ',v ~i' SAMPLE .. ,r t,L~rc ( ~4) ~w..7ri.. ~ -. 7 I i U A L MEASUREMENT 94Ubfi ] n .T PERMIT .... ,?"%# ) ]• : ,.L t~«.: ~:f :t.+.: _~: :t':^. ... ':r '. £F/[.T 'Iil'RT ~FFLUENr ;°~i5 VA.r.4h REQUIREMENT INjT Y1;X NQ=0 {::~-~: NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF l AM FAMILIM WITH THE INFO AW THAT I NAVE PERSONALLY E%AMINED MD RMATION SUBMITTED HEREIN; µD BASED ON TELEPHONE DATE (:ich:~rd Mllls OBTAININUG THE NFORMATON IIAB TTEDE NFORMA T m B ~ EnvlranrnelTtal Manager , ELIEVE HE SU MI I TION 3 TRUE. ACCUMTE µD COMPLETE. I AM AWME THAT THERE ME SIGNIRCAxi PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING 170 870-27T2 } ~_f1 QC '[y jY THE POSSIBILITY OF RNE µD IMPNSONMENT. SEE 1B U.S.C. 1 1001 µD 33 S 1 131 e P WS d ' V C w / SIGNATURE OF PRINCIPAL EXECUTNE TYPED OR PRINTm . . l r . u Ar e . . wr m!vnA nleY cAM. .+. W ro ! IO,QDp uM amuvnun inpiawllevt e/NMwn 6manNS UW 6YAVa.I OFFICER Oq AUTHORIZED AGENT CODE NUMBER YEAR MO DAV GVMM[N I a AMY cnr ~nnn I wn ~r nn I • win i Iona InerorsnGe en snecnrgen(s ne/e/ ,i 4•TL L'A+L' S7i.: ~$ l.L'"I" Ii lAIV F.G (L7C '[IF) ~4LT rc >I~-V^~ ~!I-un no-r•rp T' T..,-.~ •inn j, '.. "' . PC ]H, r')'I n'I4n;;N [J° or .7'l I' R°1174'rvVT`i• 7IL ,,"EASE-Sr? ~nrm r;nTr r/F rr, -`~ ..._„rv I:a~jN 42D'TLrT TN='T~'1 "-"T'iNr-F llT ~. -ETC n/ EPA Fam 3320-T 108-951 PrevlDU9 edluone mey be used. (REPLACES EPA FORM T.LO WHICH MAY NOT BE USED.1 ~,[ Z Z ~ / ~ „ n, _ T ;, , PAGE [ OF