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PERMITTEE NAME/ADDRESS pnd~dv FsdiryNsa/ToeaNa //DObwv) <br />NAME LYr'~wJ i_MNi,;~. ~ .-~~;.,.Tll,ly <br />ADLIRES$~'F iu OL'!( f•~ <br />Y.~ --"-i"ALu L~ tl162G <br />NATIONAL POLLIlTMT DISCNMOE ELIMINATION eYBTEM //NPDfSI Form Approved, <br />DISCH~ R6 E MONRORINO REPORT IDMRI OMBI Nou20•+Iy~-0004 <br />E7-19 J JF :~ 1 iY:_ N I L 111 L 1 /~ 1 ~) ~ <br />_ Approval skl'piree 0~5-31-98 <br />PERMIT NUMBER DtscNMOENUN18iR 1= - r 1 tvAL <br />FACILITY CYt'iwS CMPItE C YuriAllurv ~, ~ <br />i1 r~rllh <br />MONITORING E I•D <br />LOCATION <br />( <br />KAL: "' BAR MO DAY V /iR. MO DAY <br /> <br />, <br />+ <br />~U ~~1bhS FROM c r ~ <br /> <br />0. (, To 0 3L t••f~ i+L. ,.1:,L:nAr.o~ <br />a T r h r, l i; tI a E ~ r+. 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' <br /> SAMPLE <br /> MEASUREMENT ~ <br /> <br />. ~: PERMIT .. .. -.~:s <br /> gEQUIREMENT y r~;: <br /> rY .. <br /> <br />:«: _c:.. .... ..:.. <br />,.. <br /> SAMPLE <br /> MEASUREMENT <br /> <br />. ,~:,... <br />~ <br /> <br />::REQUIREMENT. : <br />.. .r.,, <br />~.,..y.:. ~ <br />". <br />~ <br />~. ..: <br />~ <br />.:: ~:°? <br />~ <br />, ::.~. <br />~ <br /> :._ '..: :.: . <br />, <br /> SAMPLE ~ :d s <br /> MEASUREMENT <br /> ~~~~ PERMIT. ~ ~. <br />~ <br />~~ , <br />~g~~ ..'%, ... ... <br /> REQUIREMENT <br /> <br />~~ ~ ~ "` ~~~ <br />. ;~::.: ? <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />~ <br /> REQUIREMENT- ~ ~ ~ .:. :.., :::c: .. <br />,.. .,:.~., ..I..:...::~ <br />.. <br />.,..~~~ '`:°r <br />NAME/TITLE PRINCIPACEXECUTNE0FFICER I CERTI <br />AM FA FY UNDER PFNAl7V p i <br />MILIM WITN THE II~FO *w.TNAT. at^ PERSONALLY EXAMINED MD <br />FMAA"f10N'~SUBMtl7ED NFAEIN; MD BASED ON ~ TELEPHONE. DATE <br /> MY INOUIPY OF TNOSE INDIVIb U <br />S IMMEDIATELY RESPONSIBLE FOR <br />flicherd RII111s AL <br />OBTAINING THE INFORMATIONr I BELIEVE THE SUBMITTED INFORMATON IS -~~ ~ / f/~~ <br />~ <br />~~~ <br />/ <br /> <br />TRUE. ACCUMTE MD CbMPLETE. 1 AM AWME THAT THERE ME <br />SIGNIRCANT PENALTIES FOq SUBMITTING F SE INFORMATION <br />INCLUDING ` <br />. <br />JJJ~ ~ <br />// <br />Fnvironmenta! 44anEV Cr <br />9 , <br />' <br /> THE POSSIBILITY OF RNE MD IMPpI50NMENT. SEE le U.S.C. ! 1001 MD <br />Si SIGNATURE OF PRINCIPAL EXECUTIVE ~ O_7 7 ~ R QQ <br /> U.S.C. E 19to. InrmlaY. utWr Bur mruna Ir1.Y NcII.eP rl.s w ro !10,000 <br />' <br />TYPED OR PRINTED .ns a~muivlVn irw•ivwr+r P/bM.rlsmonNa ArMeFral OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRs/erence a//ettecllmenfs hale) <br />~cTrLtauL~ S~Lf~~ Llalr //A11Lu rUh 1.:Yh:aLYNn I~YLI-IE fCyiL:'~7~~LL r.N.~F i',l IMF rl.l~ ~Luuli-LM~nTS• V1L i. <br />L,KCASL bKAb SAMPLc aNALY~IS rtr.l.Jlr.cU i~ YI~LdLt SHLi_{v 11 L::~LKYiiU• WF:7<LY ~„I•~F'Llhu [NST1tUCTLL'I.5-l.'_.d. <br />Ji a. <br />EPA Form 3320-1 IDB•B6) Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 0 J L 12 / `/ b L U U L ~ k~ 1 PAGE L OF <br />