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PERMIITEE NAMEIADORESS (IMrLfrWryNax/taenm yob/ <br />NAME - ; .. p •: ' •. ' . <br />.. ,.. .. 1~.c L~~w' r@ <br />ADDRESS •:: • .~ :. L t- •. ! +• }: <br />Ir, s rl rr~ Av ..1 ., <br />1 j. I 1 1'a' . { w C ,. -~ (.~ ~ <br />Lt I: a ,. ~ •. ~. ~, ~ ~' 1 p 1 <br />FACILT' ., ~.: f c ..; ~ ~ : u `.- S.. . ~,I V 11 r T h) <br />LDCATIONw-L.rva-'t- ~ "1 4 7 !1 '71 <br />NATIONAL VOLLUTMT DISCXMOE EUMINATIOx SYiREM (NPOE$1 <br />DISCHARGE MONITOgINC REPORT (OMRI <br />2.16) I7-191 <br />,-.fir. I~I•,~ '• OT ~ <br />~ y PERMIT NUMBER DISCNMaE xurAeER <br />y "1711 MONITORMG PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ '• t I TO "' ' <br />nala vaa.Tl rwcr r]~]n vaavl r.Tnan <br />Forth Approved. <br />- •~ ~ ~ ~OMB~No. 2040-0004 <br />., . ; ~ ,~ Approval expires OS-31-SB <br />,nn <br />NOrtE: Read Imtructlarr befor(~Mtlny thin form. <br />PARAMETER 13 GrC Only) QUANTRV OR LOADING /~ ~OnlYl QUANTITY OR CONCE TRATION 1YO, fREDUENCY SAMPLE <br />/32-371 146-531 15461) 38-151 H6-53 ~" 15451 EX OF TYPE <br /> AVERAGE MAXIMUM UNITS INIMUM AVERAGE MAXIMUM UNITS <br />Ie4~01 MALrss <br />/5468) <br />169-701 <br />" .') ~~^ !. +} yn~l ~ 1.^) SAMPLE ~• ~ ~ ( .' 1~ <br />.1,•. ,, MEASUREMENT <br />.. r l ~~ ;1 PERMIT ~:-,: ^, a:a f.: ~~ <br />~ ~~:%xrrt, "~ :.. ~....~,.:~::., <br />1 ~ <br />.;t S'».... _. <br />tiyk~.tc: ~~' .n't.x i'EY, <br />vr..: :r. .~,. ~. Y 8 r ~ ~ REQUIREMENT ~/ <br />:... . rc'r .. <br />~Ilrn'. _;"r <br />' <br />' SAMPLE . ..^CG .. .+~;TDIX:O ( ''tl <br />r . •.: <br />„ <br />~ ~ ; ~, MEASUREMENT <br />:'. .' U U ':...PERMIT .. <br />Y. .•':r n~:rgr~pkig6; r-: I:^F '.:;~i~~ ..:.,,,..-: <br />... y!C~a`:$:7¢:1 r--._ .~rr.t~Y~ ;alt? <br /> <br /> <br />. <br />p D S ; Ir q t• ;1 ~, <br />,REQUIREMENT <br /> <br />,-: <br />~ . <br />004 <br />i x <br />(• ~, ,; ,. <br />. . <br /> SAMPLE <br />~ <br /> MEASUREMENT ~ `E <br /> 'PERMIT ~ ~ ~ .. <br /> .REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT <br />1. ~~j <br />/ <br />~, ` 1 ' ;1 <br />H µ- 1~ <br />1 / \ r <br /> .RM ~ ~ <br />~ ...: ......~:.:... <br />~.~~ ~ ~~ .... ... <br /> ~fiEQUIREMENT~ :~ <br /> SAMPLE <br /> MEASUREMENT <br /> ::;::PERMIT. ~ : <br />.... <br />. ..:....... . .. <br /> <br />. <br />:..: .:.::..:..: <br /> ;pEQU.IREMENT . <br />.: <br />:..:: <br /> SAMPLE <br /> MEASUREMENT <br /> ::..::PERMIT . : ~ ... ...::: .;~...:. .. . <br />~ <br />~ <br /> HEQUIREMEN'f: ~ ~~~ '~~~ ~~ ~ ~ <br />~ ~ <br /> SAMPLE <br /> MEASUREMENT <br />~..::~.;PERNIIT:...~. ~.. ~~ ...; .;.... .. <br />,. <br />~ <br />'.AEQUIRE6AENT:'. ::. ~ :• ~ ~ ~ <br />~ <br />NAMERITL! PRINCIPAL E7fECUTR/! OFFICER I eun <br />AM FA rv uxQER nNALr or <br />MILIM WITH TM! INFOR uw TNAT I NAV[ I+cR[o <br />MATION eU[ <br />ITT[0 N NALLr ExAMINFD MD TELEPHONE <br />[IN• M <br />{A DATE <br /> <br />MY IN M <br />ER <br />D <br />elD ON <br />QUIRY OF TNOe[ INDIVIDUAL[ IMM[DIATCLY RfVON[I[LF F <br />' <br />r <br />1 ~ I' /. ~ "~ <br />0[TNN <br />TAUT OR <br />INO TN! INFORMATION, I [R.I[VE TNC [U[MITT[D INRORMATION I[ <br />ACCUMTI MO <br />OMF <br />I <br />T <br />T ( <br />~ <br />` '-' <br />/ <br />1' <br />~ <br /> , <br />[IONIFI NA <br />C <br />iR[. <br />AM AWM[ <br />TN[RC M[ <br />CMT F[NALTI[[ FOR [U[MIT71N0 FALa! INFORMATION <br />INCLUOIMO I• <br />; <br />,(~~V <br />1• l u , I A 4 r Tx[ -0 , <br />[el[IUTY OF FIN[ MO IMMUaONMWT. KE 1\ U.e.G. [ 1001 MD ]] 1 <br />ONATUR~OF MIINCI-AL [XECUTNL " ' Y(.'1 ~ ~' i ' r7 ~ (i ~ C. <br />TYPEDMPIIINTlD U.e.t. <br />eMFrr 1 177[, lllrYallE I(I/Er eMM ~bNtIE rnFF YltArel lMIN 4 ro I f0,00O <br />nvimEnllyN/MINfF/MewrwlmmerFAMaYAVaI OFFICER ORAUTHORQEDAGENT NUMlER YEAR MO DAV <br />vvmmcn ~ ~ nnv cnrcnnn r rvn yr nn r .wcn . rvna In~iMnxe en mecnmmo nqq <br />. .. d. 't .-)~ .~r ~e:L T?~. P9O~-D!1^. .'r - !. •^ - ~?,"Tcn-rel. -r.j.,T ... 'l.,rp ,aLf;•1' :. <br />1. t..'1~1L r.,,ti~l:, c ~ :T T^._E '!~ A'fTA~H !.'i1^! TnTIr'°~' .. r::_•r,•,r• P^'~ _r. ,rte. r,~hT: `~ 4[.L <br />VA'Fam ~ii 0.1 i06b6h 'hedotie edltlona may a u[ed. (REPLACE/ WA FORM T40 WHICH MAY NOT 0E WED.( ,•I ~ n 2l'. /'a f. 121 J - 1 2 21 PAO! ,OR <br />