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PERMITTEE NAME/ADDRESS priW FrAlryNrdlx,nm lJD , NATIONAL POLLUTANT DISCHARGE EDMINADON SYBTEM /NPDES) <br />DISCHARGE MONITORING REPORT IOMRI <br />NAME ~?' <br />~( <br />-~ <br />; / <br />~' ~ ~- , ~ <br />, <br />w <br />~ - P <br />Z-J5/ 77-191 <br />ADDRESS :I::~ .{Ld *r',~~ <br />2'7 <br />~ ~n~~oovoe DI A <br /> j N b 1 3 5~ l/ I t t r~ l <br />1 pERM1T NUMBER DISCHMOE NUMBER <br /> ,\ ~ <br />FACILrrv <br />' MONITORING PERI00 <br />' "'~' " <br />' ° • '' YEAR MO DAY YEAR MO DAV <br />LOGTION y ); S TO M S; r~l Lo, ~.v D 1 I. D 9I FROM TO ! . <br />R T T N : ' ="i ° R A L m : R . (?6111 11I-131 l11-T5I (16271 (18-29! /30-311 <br />Form Approved. <br />D ~'7 F.;T I C ~ F V A r c ~OMB[Nq.r2440.',UUp4 ~,I <br />( ;11?P SF.) ApproveL~Ixpire++505.31~98 <br />rs <br />F - FI'JAL , <br />-rrinP. <br />oa^• R^ blSrl?ARf;° ~__~ apC <br />NOTE: RBBd InetrueUoro bB1orB oomPIBEInQ EhiB form. <br />PARAMETER /3 Grd On/rl QUANTITY OR LOADING !4 Grd Onlrl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> 10653/ I5L51/ 138451 (/653 /5L5/1 <br />/3Z-371 EX ANAlYSIB TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /s1.s~l /6q-581 !5&701 <br />El')D, 5-!IIIY SAMPLE Sxa~Pa aaaapa eaaapp ( I?) . <br />(L(7 D`~.. C) MEASUREMENT <br />UD.iII) A D II PERMIT: $$¢*St:C.: <br /> <br />~ :,:::.:'.kP'R,6.?.~.:. dC: C:AY114$'w~ : : '. $ <br />P ff <br />15 ,R1' <br />~ <br />....1jPp <br />flt!r <br /> <br />~ <br />~~L ri~'~:A <br /> <br />.. <br /> <br />iIISI RP4^?, PRCS :'SID [, <br />;REQUIREMENT <br />~:~ ~ ~ ~ <br />~ f: .'.: ~.:: ~ ~ . ~~ <br />.~. ... .. .: ~. ~ <br />~ <br />~~3~O~D l.;:ltr~ . <br />~:. ~~.~~~% ~~T p~.:A~Y <br />/L <br />~ . <br />~Z!O!1C.1'... <br />i`/{ SAMPLE C-!`-a4::. as;Faaa riz:a~aa ( I-r) <br /> MEASUREMENT <br />U U'I i7 i7 4 D D ::~. PERMIT ::. aat~~~a~se:a. ~'r :..., ~~Paii il:!R 11..A)..: <br />: <br />. <br />: <br />,: .dI >Za :' ~ R.P.PQ R'f ~ ~ ~~ #r%kG^.xF .. :. : ~. R.~~.~'~~rt'T:: <br /> <br />~ i; <br />iP:»Et~ <br />k ~ <br />:TN.>TTr <br />D Lit NFECT, RRCS °"PL REQUIREMENT. <br />.. . <br />. <br />. <br />. <br />~.::~ C-aaR s.~*T:p~T~.lIf7.K ~ ~..:}?A~j ~:wE{x ~ g'I ~ <br />::. . <br />, <br />::<-;::.: ..'.i.:~ ~. <br />3uLID:;, T'I~AL SAMPLE <br />MEASUREMENT .saa^c. aaaaaa r pay,;: <br /> <br />) <br />( <br />ti U~ P h: N 7 =. G ~ <br />(7 1 A <br />7 5 U D - D ;:.:.~P <br />~:..... ERMIT::::~ <br />~ ~:~:a.a~a<IC:¢. :~. <br />~'. 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F.Stl .~ryr;:a^ ~ p.e::. ~ <br />~ '~n_py: r:. <br />JISIVF'i'C".RRCS 'yP <br /> <br />6' <br /> <br />:REQU.LREME~77 <br />r,:..;;: <br />:~.: -_....-. <br />. <br />. <br />. .: .: <br />,..3~N ST:.::1FIl1L:' <br />N ?= p <br /> <br />,r .. .;:: <br />•: r., r a .. .. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER J cERD <br />AM FA Fr uNDE}IyENALTY OF lAW TNAT I NAVE PERBONALLY E%AMINEO IWD <br />MILIAR H THE INFORMATION SUBMITTED HEREIN <br />D BA9ED ON TELEPHONE DATE <br />~F' ~ <br />~.J ~ ~.' ~ ; AN <br />MV INQUIRY OF THOBE INDIVIDUALS IMMEDIATELY RESPON9BLE FOR <br />OBTNNING THE INF011MADON, I BFLEVE THE SUBMITTED INFORMATION IS (~ <br />l <br />\ <br />I <br /> TRUE, ACCURATE AND COMPLErE. I AM AWARE TNAY TNERE ARE + ~ <br />n <br />T <br />/ '[. <br />V <br />_ <br /> <br /> <br />, µ <br /> <br />BIGNINCANT PENAlTlES fOR EUBMITTINO FALSE INFORMATION <br />INLLWING / <br />~/ <br />~ <br />I'P <br />[ <br /> <br />7 <br />' <br />A ^ ~ / <br />~~ E / µ <br />fi , <br />TNE' POSSI&LITY OF RNE N!D IMPNSONMENT. SEE 19 U.S.C. E 1001 AND 9] <br />II <br />SIGNATURE OF PIIINCMAL E .~~ <br />~J--'' <br />`{ <br />~7V 9o 4I Q4 <br />"I <br />I r) 1 <br />U l <br />'I 1 , <br />Y1 <br /> <br />TYPED OR PRINTED U.S.C. f I~IB. /hMil uW eNr .e.im. n.r tir4nY, IYI„ w ro t%oav <br />mdnnr.in.n hrorirnnrr a/bww,smprol, rVSrrrs/ XECIliNE <br />OFFICER OR AUTHORIZED AOENi <br />C <br />E <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> OD <br />_......~..._ ...... ..,.. ~........_.. _. ._.-. -._~...._.._ ..._. ~. ~....~ .... ~....~ ............ ..~. o. <br />iQ PAT A9 :RA9'' [S 4I^, ~•?SP °?4Ti[.Y AY::. 9Jf; I'7 (' P'iRL'lp R^P^r'T'•n, '1'L ~ ^v-•~-'•. _ -r: r. .±.'} n, T <br />mey <br /> <br />~OF <br />