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<br />PERMITTEE NAME/ADDRESS RMrbix,Gry Nw/L«snm VDlO rxe)
<br />NAME rq ~U.. ?Av ,F qa Lr~.Y '74i. ~7r~.~
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<br />ADDRE59yl L,'~i iJ ~'~) Sr r ~'F, '1 A', ^(
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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM INPDE$1
<br />DISCHARGE MONITORING REPORT (DMR)
<br />1T-161 /17-191
<br />~~n'72~1c'1 pin
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM I TO ~''! r
<br />116711 l22-731 11475/ (16171 !TB-T9/ !3631/
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<br />Form Approved.
<br />.• nOMB,No~ 2040-0004
<br />Approval, elCpirj a 05-31-98
<br />NOTE: Raed InetrucMoru before~Leo~mpletinp thu lorm.
<br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING !I Grd Only) QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> !16531 15457/ l38-151 !0653) 154511
<br />EX OF
<br />l3T-371 µALY515 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sT-ssl !54581 !5&70.1
<br />FL01+J _ ;:/5'_19TT 4 SAMPLE ( lji .,.. r, .,... y.+, ..~.:. r,r:.:. .,.
<br />*HHU T r, i~;'^'O'° nLe!'" MEASUREMENT
<br />50U`•O I (' (: PERMIT AP.?~4T ^OPU17T k'~X:rt;.':!. w~~.A ~,.f....,.. ;: •: r: FFPLY y~T,,.
<br />k:FFLQe' "' "''~°~ 9ALE1% REQUIREMENT 30US iYC CBILY `IX fF;J '` "'-~'
<br />SOL.f!5E 1'1°A1. SAMPLE ~z::+knC# '`;::``.~? . . . .•`r,: ( i`71
<br />D I ~; _, ~ L Y~ .~ MEASUREMENT
<br />U.'~] ~ 7^. PERMIT 3iti0~~0 ~;:-m#:t: Q t#r ~a^t;it;':.'.- o-.'n(~o^ D"Ar1`m HRi`F./ R'!':
<br />.°FF[.Jr',`,'Y -^'1iS YP.LU REQUIREMENT 3r1nf 'vr: n+,T.4 y•r ;/i. !97V T'1
<br />)IL .1 d1. ,.t>E^~:: SAMPLE {e .4 'f hh.k ( J~~ ,~•••~!-,•,•. +: e4:x •:: _" Ytf':':i:ir
<br />I i J A L MEASUREMENT
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF L
<br />MILIM WITH THE INFO AW THAT I NAVE PERSONALLY EXAMINED µD
<br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
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<br />, MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ /~
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<br />'' TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />AGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />RISONMENT. sEE 18 U.S.C. 1 1 W r MD 33
<br />1 1 Jte BIONATURE OF PRINCIPAL EXECIRIVE
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<br />TYPED OR PRINTED U.S.C.
<br />. lwvlw/ uW~r N.w mroNa m.Y 1ncMh fw. 4F ro t 10,000
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<br />OFFlCEq OR AUTHORIZED AGENT AREA
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<br />CODE
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<br />COMMENTS AND L:Ar•t.wnw I wN Ur wm vwLw I was Irtererence en srrecnmenrs oars!
<br />JI:. .°. ~: ". `!c' _ -cF! cl)'1P ~; J^c P/.• ~. '.. "YT 47fl n^'('c. ('rj1r. rT,. r...~ _ .,r, :r~nm-.arc r~~ nnT- -.v DT ~,--IL.J,'1
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<br />EPA Form 3320.7 108-951 Previous editions may be used. IREPIACES EPA FORM 740 WHICH MAY NOT BE USED.1 ~ ~ n ~ ~ PAGE ~ OF
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