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PERMITTEE NAME/ADDRESS pkrJ. FrNIryNwWlecanm pDlp..r0 <br />NAME ~+~',~~ vE •D~ V'.LL' '~~'~L '7~7. <br />ADDRESS. `, 1 '. - . ~ L ~ ) 3 '.~ 1 ~. ~ _ 1 <br /> 9~LU11 F~,::r W;F•~.I:•,r. .-~JCLF- <br /> <br />FACILITY <br />LOCATION <br /> <br />~~ 4 <br />k:' <br />s' . <br />1 <br />;5 <br />a.:= <br />NATIDMAI POLLUTANT DISCHMOE ELIMINATION SYSTEM lA1pOE$l <br />DISCHARGE MONITORING REPORT lOMRI <br />!1-f 61 17-191 <br />°Jf?0?7114 rl~ t <br />PERMIT NUMBER DISCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM '. 1 TO ` "' 1 ' - <br />I1Q111 11b131 114151 II6171 11e-191 130-311 <br />,f~„ nTVt/ <br />.. ~ r <br />Form Approved. <br />.,.OMB No~2040-0004 - <br />Approval expires05.31-98 <br />L ' 4 ~ <br />l~ NOTE: Raad Inetructlolu before eo`mplatlna this form. <br />PARAMETER !3 Grd Onlyl QUANTTTY OR LOADING 14 C.+d only! QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> /~6-531 1546/1 3B<5I M6631 !SI-611 <br />EX DE <br />E <br />131-371 ANAiYSIS TYP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l6I.631 /6q-681 163)01 <br />Ya7:; A`1 :: T~Tlt SAMPLE ..k_t ::^ Ip ~: ~..~ ,. f_,. ,:{: <br />F '. 3r`&. <br />i , O) <br />~/ <br />l~ <br />nA~ <br />: <br />;C7Y . <br />') <br />: MEASUREMENT V'~ c ! O ~ . <br />, <br />. <br />. :~ <br />11111 - :) '~ PERMIT :#::u:tS ~~uR: :' « 5:;. ~,y.: ::-,. 1 n ^eTn'. ~ 1 1+I~ :>' ~.yL^~r. <br />[I'FI,VL Y1L11[ REQUIREMENT ::. r;;;±; ~rl ... r,. riY ^'r „(;/t, 'a ,-•.-"1 <br />F'LU41r f ,^_'~ti?7!!' r1R SAMPLE °~ 12 <br />TF ~ <br />} ( 131 -..y ~._., ,: <br />O <br />~/ r~ <br />~~T <br />L'.i ~i G T r ' 1 !. ' ?'i " P U N T <br />- MEASUREMENT ~~B, D ~ 31 V <br />• <br />~o„sl~ <br />1 0 ~ PERMIT Ri~»r. 3F~~14T xnrfm-~:= Lam'.". :-x~..: ...~;~;~:~ , ~.... ; ,, r,- <br />1, <br />F'L ~: '~.'. '~ > ~.- V"LfIE REQUIREMENT jOilA APr. dAIYY *1X `!GO 4i;: ek ix '~ 1,.~^'+ <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/TfTLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />ANI FA FY UNDER PEMUTy OF L <br />MIUM WITH THE INFO AW TNAT I HAVE PEflBONALLY E%AMINED MD <br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON9BLE FOq <br />Richard A.lills OeTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />~ <br /> <br />a <br />e <br />l ! <br />t TRUE, ACCUMTE MD COM0.ETE. 1 AM AWME THAT THERE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING f/ <br />~ <br />+ <br />nag <br />r <br />a <br />Environmen , <br />THEPOBSIBI <br />TVOFRNEM <br />PWSONMEM <br />SEEIBU <br />S <br />C <br />11001ANpGJ <br />v 970 . <br />'97~_77~ ~ ~~ 9S <br /> . <br />. <br />. <br />U <br />DIM <br />T. 61GNATURE OF PRINCIPAL EILECUTR/E <br /> U.B.C. E tJLe. IIYIWei. LnNr err mem. mq NchW rvr. W ro t 10,000 AREA <br />TYPED OR PRINTED rM wmuvnlm lreriolnrrlt of Mnrrn enwler rW6E~wal OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />'~ COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Re/erence ell sttsehments here/ ~ <br />CE1•:;:'"fl',•: 30-G4:' AY~Oe1, '^,q^pI,Ti1PPIl': 7~IIJi A ~'(`N"1L AZ.f;~Mrr~r yr-~.~ nr ~Ti .. p,,1'i -~c, lr^~ r~.17Li^i ..-:1,~ i <br />~A`PL::.. ~;LL^-,-C .1T :'Iv`5 ')O1PE J95A r.ti~ :)')7R JU4[g Tat gFTr~umrp^ nF[+r~;._T~ ~~ •J^ ~.~~ i <br />,~ <br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.( n ~ ~ S . ~ •r o Grl 07 -1 (? 1 ^ PAGE ~ Of <br />