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PERMITTEE NAME/ADDRESS !/«Y4 F«WryN.wl«onm UDrpmnq <br />NAME Cy ):. .. '/Ri'? V,?'1,?Y ':14[. CJ~:7• <br />AQOREBS ~~': 'i IF ): { ., i,-7' "'H, ~ F~K"'E."7 ~,.. <br />, '';L~ .,,, c~ ,~~ ti , <br />FACILITY <br />LOCATON <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM INPDESI Form Approved. <br />DISCHARGE MONITORING REPORT IDMRI .. r. ~ T ,.. .., ~ OMB No:.2040-000A <br />1-1s1 m-le "' • T <br />,. ~ 7,1~ ~ 1T ,I „~,, v Fem... ~ , ~ Approval expiiee 06-31-98 <br />PERMIT NUMBER DISCHNiGE NUMBER - <br />, i. <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM .. 1- :! ~ TO ~ . . •: ~. - ~ ..-l.., . ~ ~ ~% ,. ,. <br />!14111 l11-131 !14151 r16171 l16-191 134311 -NOTE: Read Instructlau balors COTPIatIDQ Chia form. <br />PARAMETER !3 Grd Onlvl QUANTITY OR LOADING !4 Grd On/Yl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> 146-531 (54611 138451 146-531 154611 <br />EX OF <br />131-371 ANMY$IS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (61.691 16q-6g1 169-701 <br />P'%X IC <br />":Y SAMPLE :T~ . <br />., ;t 1 <br />. <br />r .... , <br />, ., ... ~ <br />d 1 "! = 2;1 ), L c: ^ I; p ~ y T r MEASUREMENT <br />1'1211 ] C 0 PERMIT G-`-~"S ~R ': 'X St:{Fv .. A i!¢f?R.T .y.: ~.«a,. .. ,r r .m; Lv .n..r7.. <br />iE~ "'J .."'54T5 rlrL7~ REQUIREMENT >r':xR 1Y V6E.t!f "'C' <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENN.TY OF IAW THAT I NAVE PERSOMMLY E%AMINED AND <br />AM FAMILIAR N1TH THE INFORMATION SUBMITTED HEREIN; AND BASFD ON TELEPHONE DATE <br />~1II <br />i <br />harr~ ~' <br />F:i MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR / <br />/ <br />. <br />. <br />c OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION 18 ~ <br />~ <br />~ / ' <br />~f <br /> <br />1ana er <br />l ^ <br />t <br />i <br />TRUE, ACCURATE MID COMPLETE. I AM AWME THAT THERE ME ~ <br />. <br />~ <br />• ll <br />. r~~ <br />a <br />: <br />rrnlT~n <br />~nv SIGNIFICANT PENN <br />TIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ <br />ii <br /> . <br />, <br />THE POSSIBILITY OF RNE AND IMPNSONMFNT <br />SEE tB U <br />1 1001 AND 3G <br />S <br />C ~ L17O ~ / ~- ~ J ~ J <br /> . <br />. <br />. <br />. <br />u <br />B <br />C <br />1 t7U <br />li <br />ri <br />M <br />t r0 <br />0o <br />I <br />' <br />610NATURE OF PRINCIPAL E%ECtlTIVE _ <br />TYPED OR PRINTED . <br />. <br />nr <br />. I. <br />, <br />0 <br />. <br />. f <br />r awAr mnm. nvY <br />/w. ro. w ro <br />+L <br />.n6«mArMUn inpiaamwnt olMMwn 6mend,a A,M 61+A'Al OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA 71UN5 IRatarence el/ sUSChmenfs hare/ ' <br />.,-_. !. '.ti !'lu nc nA 71. `.i. qs•;t (JR~ Dt.'y ~ILCS <br />NT ,:(,*~7,.YN. .~c~"T' L"L.~~* ., vcclir?„T 7F L'.TGA'.IYY [)=VTgS p`~ <br />AP R~I'i1 ETA'"?S~"i;'~LT.°. uyccc o•!•-rnr r~>- ..y .. - <br />4I (.'!'7F ^. Tcc -~r~ .. .. ,... ,, ...TVj ,.. <br />- ,-,-..., .n. R~•~ ~ •n. . <br />••• T ^11 eCV q T^ 1!T T:: TT -t C\~' p M T -1 n/1V TT ^t Vq^•rr - <br />^ 1, <br />EPA Form 3320-7 106-961 Previoue editions may bs used. IREPLACE6 EPA FORM T-40 WHICH MAY NO ~ BE USED.1 <br />D n ., ~ ,I V,) T ~,I ~ -, _ ~ „ ~ ~ PAGE ~ OF <br />