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PERMITTEE NAME/ADDRESS p.dd. P~WryNaWL«anm dD,d..w0 <br />NAME T.: r.l •'.-. ?'ii :..~ ~. _• <br />ADDRESS ~~ I` is i+ F' ~ !t .° ( 4 <br />%Nh C~, i;,t „lolu <br />FACILITY <br />LOCATION <br />Ti,'i: W. ..0'tLJ~ i'i' nFc,r -'CS/;C:~ YG3 <br />NATIONK POLLUTMT DISCNMOE ELB,IINATON SYSTEM /NPDESI FOrm ApprOVed. <br />DISCNARGE MONITORING REPORT IOMRI <br />n-r6~ J7-rs FC "' C d' ?0 ~ T ~ r L AI"1~1t4°.g28r0-o0,0~~ v <br />0 0 0 ~ 3 211 `~ C A (!' ~' a F ~ p) Approveli xplrpa OS-3 -98 <br />PERMIT NUMBER DISCNMGE NUMBEA F- F I A b L <br />MONITORING PERIOD ° T- NC F <br />YEAR MO DAY YEAR MO DAV <br />FROM TO 1 _ 7:`=' NC CISC6P,RC,~ )__~ '.. . <br />116111 l1I-131 171-151 176171 l16-191 1363!7 NOTE: Reed inetructioRe M1we completing this farm. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING /1 Grd Onhl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br />I3T 1~6-53) /51-51) 138-151 !16.53 /5L61I OF <br />-371 EX MKYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lett7/ 16F66I 169-701 <br />.,•,• ~ SAMPLE ~'•+4R •,: ( 94) 4r+9fiCrt t*:fi'K~fi nt:~+:>`--:` <br />y L -i U A L MEASUREMENT () U ~/~ /fkNl <br /> <br />~'µU6G 1 O 'U ~~~:PfRMIT~::.. <br />:, .. ... ..' 1+=' =X?X ~~ $~$ .p&.T t-°=1 6#g9~RF? .4a<'iTC+p.4 ~~li4iCq#~`? :4"X;1 £RKL YI_SUA: <br />~FtiUENT ::ROSS YALJ `JtEdUIREMEN7 <br />,...:. <br />. ~ .. <br />INST kAE:. <br />NC=0 <br />4b4Y <br /> SAMPLE <br /> MEASUREMENT C, <br /> PERMIT ~ :. .... .. ... , <br /> REQUIREMENT ~ ~ ~ ~ - ~ ~ ~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ .. <br />- REQUIREMENT <br />;i 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 />NAME7TfTLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENKTY Of LAW TNAT I HAVE PERSONKLY E%AMINED µD <br />MILIM N'ITN THE INFORMATION BVeMITTED NEREIN; µD BASED ON TELEPHONE DATE <br /> MY INOUIIIY OF THOSE INDIVIDUKS IMMEDIATELY RESPONSIBLE FOP <br /> <br />N <br />Gordon Patera OBTNNING THE INFOIIMATION, 1 BELIEVE THE SUBMITTED INFORMATION 19 <br />TRUE <br />ACCUMTE MD COMPLETE <br />1 AM AWME TNAT TNERE ME / /~ <br />ILA C <br />. , <br />. <br />SIGNIFICANT PENKTIES FOR SUBMITTING FKSE INFOIMATION <br />INCLUDING 70-824-4401 99 4 2g <br />President/General Mena er , <br />THE fgSSIBILITY OF RNE MD IMPRISONMENT. BEE 18 U.S.C. ! 1001 MD 35 <br /> <br />E 171 e <br />lhlW <br />U <br />B <br />C <br />i <br />I <br />fI <br />/~ <br />E <br />W A <br />S IEIONATINIE OF PRINCMAI EXECUTNE <br /> <br />R PRW <br />TYPE <br />ED . <br />. <br />. <br />. <br />e <br />.,/I <br />MM .OEIVlr. nleY <br />Y <br />IC. <br />. <br />IO,Oaa <br />+r+W b <br />D O <br />T Ilnawm.aYnun llnwNelvrwMWe.IwNasmenNSllads wval OFFlCER OR AUTNORRED AGENT CODE NUMBER YEAR MO DAV <br />L:VMMCIYID XI9U CArll119LIIVIY Vr qn1 YIVLLIIVIYJ IneFe/laG1 N/IRICI1TInl3 DIle/ <br />i~3 t; fU'PAL IR04 LI`!ITS WILL yF WAZVLD, ANIi SETTLEAF!LE 5]L ICS IIMI? FFFLiFD FCF <=l0YP,2u9F f`F:~CiP F"7~'AT- <br />~`-. 6UkDFN OF' ?;;GOF hE1UIR`,!:EtiTS UNIiE4 I.A. 3. TUS K9::I'P~f7IFG - 7.9.3. CIL E f,FEASP. - '. F. c^ I. H. 1.(U). <br />Ji/ ilAY AY EP.AG k' LS NI(. hF:ST Nl1N TN1Y EY%HAG~ 'l 11pTYr: ptpT l^ OF Cf URFr <br />EPA Form 3320-1 108.951 Prevlom adlnone mey be used. IREPWCES EPA FORM 730 WHICH MAY NOT BE USED.1 O ~ 0 7 Q ~ ~ ~ ~ 211-1 ~ G t PAGE ~OF <br />2 <br />