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PERNITTEE NAME/ADDRESS pw,iri FrWry NAr/Lwalan IjDlj(rwN) <br />NAMP <br />ADDRESS -, , :: 1 / ; ~ : ; r'. i •. ~ . <br />+ r. +. r 1! <br />FACILITY ~' .1 - , { ~ - - ~ ; ,~ ~. <br />a .~q ~ ~ ,~- III <br />LOCATION - <br />- , <br />NATIONAL POLLUTANT DISCHMOE E7JMINATIOt1#•e-i aw I:~.:~SJ <br />DISCHARGE MONITORING REPORT (OhIRJ <br />1-161 77-791 <br />^ ^ M ,N MBER OISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ ~. • y TO .I , I <br />lI61// l1d131 I?L761 /6171 /28-191 13Q311 <br />~• ~: i r,, <br />>y.-. <br />Forrn Approval. <br />OMB No. 20x0-DDDa <br />Agpr03iel'e+pN6e'OB•3 F-98 <br />' ~ '- . <br />~NOYE: Reed Ifieliuctloir M`for~r~letilip Ehie form. <br />PARAMETER l3 and onlYl QUANTfiY OR LOADING /1 Cud onryl QUANTfTY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> /16-53 51.61 38-x5 16-53 15f-61/ DF <br />!31.371 EX <br />ANALVSIs TYPE <br /> A VEAAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e1-s.T/ l61-ri8l !6&701 <br />"LL d.'. ,, ..F. <br />SAMPLE <br />.. ;. r :~;::~ <br />( <LI } <br />.. <br />~ <br />.. <br />~ <br /> MEASUREMENT ~ ~ - ~ <br />' <br />T.;,'L <br /> <br />..,:t, i l' PERMIT <br /> <br />REQUIREMENT <br />;: r,.L<s~:~:;: <br />`.iy's^~;31?'T <br />-i <br />.~.~##:'r~ <br />hsS..~~t:. <br />~ :;::::;:'>;a.-a%~ <br />~. <br />Ff?N.I."~ <br />i'~';,JA <br />. • f -f <br /> SAMPLE - <br /> MEASUREMENT <br /> RMI ~: .. <br />~ <br />~ <br />~ <br />~~~ ~ ~~ .. <br />~ ~: <br />~ <br />~ .~~ ~ . . <br /> REQUIREMEN7 .~ <br />~ <br />~. ~: ~ ~ . <br />' . <br />. <br />"~~ ..:~ <br />~~ ~ <br />~~~~~~ ~~~~ .. <br /> SAMPLE ~ <br />, <br /> MEASUREMENT <br /> ~:: ~:~.PERMIT .. .. <br />~ ... <br />~ ~~~ ~`~~~ <br /> .'REQ[l1RENIENT ~ ~ ~ ~ ~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERM17 <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 />~REQUI T <br />NAMElTfiLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EAAMINED AND <br />AM FA MILIAR iNTH THE aIFORMATION SUBMITTED HERON: AND BASED ON j" <br />/ / ^~ <br />~ JI <br />II ~ l/I ~ l~/ ~ <br />~l ,~ <br />~ MY INOUIIfY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE f00. <br />OBTNNING THE INfORMATION <br />1 BEl1EVE THE SUBMITTEp INFORMATION IS <br />'~ <br />/ <br />~ <br />F <br />i <br />` , <br />TRUE, ACCUMTE AND COMRETE. I AM AWARE THAT THERE ARE <br />AGMRCANT PENALTIES FOR SVlMITTINO FALSE INFORMATON <br />INCLWINO / <br />! <br /> <br />j /a, ! ' ~/~) ~ <br />' , <br />THE POSSIBILITY OF FNE AND IMPRISONMENT. SEE to U.S.C. 1 1001 AND 3J <br />U <br />C <br />1 1310 <br />S <br />Ih <br />~ BIONATURE OF P111NCIPAI EXECUTRE <br />~ ~~~ f <br />~ ~~ ~/ <br /> <br />"~ <br /> <br />~ _ <br />TYPED OR PRINTED , <br />. <br />. <br />. <br />rrTb uMV Wr .hNN. rtir Mcpgl /Awe y ro F 10,000 <br />ArM wmuimAn E+w•/aennlnt olMtwMn 6 manrnA W e vAeti.l OFFICER OR AUTHORIZED AGENT CODE NUMBER ~ `%EAR MO DAY <br />I <br />GVMMCt11.l qNV [Ar'LAIeA IIVM YT g1Yl YIVLAIIVrYO IFTIEBIBOCe eII eRCCDmen r9 ne/e/ <br />'L ..l ~- .. •!.:' ~.= t ".=~ r '1 `i i .=1 )~' • ;l t. ^rr .t I I. _i ,.. I. ..1.-.. •,; -~ . <br />. .~ 1 .~ i,i •T~'. T, i,>i r.7,.1 r .,. i_ ..~ -a r--- i~ .-'. ~. <br />.. .. - '-. F }'- . <br />EPA Folrri~ 3320• 108•Sel Previous editions in6y'tie ueetl. • ' - • "' yREPLACES•EPA FOR T' WNIC M'AY• OT BE USED.) ' - ~ • ` • ~ ~ • PAGE OF <br />r <br />