Laserfiche WebLink
PERMITTEE NAME/ADDRESS pw.i.4 FxmryNwdfncsuar dD,pnme <br />NAME ~~~ , I ,- ._ r ... ., T 'r .^'.L .. <br /> ' rte; <br />/ y' ~'1. ~iJ y T.r~ a'T.r ':.L' <br /> <br />FACIIITV <br />LOCATION <br /> <br />NATIONAL POLLUTMT DISCNMGE ELIMINATION SYSTEM lIVPDE$l <br />DISCHARGE MONITORING REPORT lOMR1 <br />Z-161 17-191 <br />~.. M; 77~I1 •nT 1 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ] ..7 _ TO 'I' :r <br />!161/1 l11-131 /14.151 l16-171 l18-191 13631) <br />Form Approved. <br />,. c -~ r+~ . - ~OMB~Noa1040-0004•: <br />fir,,, - ..t Approve; expires OS-31-98 <br />J^CI F• .l <br />NOTE: Reed inetructiau balore complatlnp this form. <br />PAgAMETER 13 Grd On/Yl QUANTITY OR LOADING (4 Grd On/Y) QUANTITY OR CONCENTRATION <br />~ NO FREQUENCY SAMPLE <br /> /48531 /54671 /36451 /46531 154-511 OF <br />/31-371 Ex ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161-e]I !6458/ (69-701 <br />C r,! ~, =171'.~.L REM ~~••(v",.y r,_e i-J.'. Y..Y ...'.... t. q <br />O <br />' 3~ <br />~ ~ L I, O ~ ~~ <br />(:.S .) MEASU <br />ENT r.7 F 3~ GI <br />:i',i LB `~ I n l PERMIT ::'tfi 2=-(:'i ^.:~;t¢r:: f !`?:, ;: r'-^r•:Y,' ?rS 7rr' ' Y";•f :t{;( <br />v t' -' ' '7 - ; _ V `, i. n v REQUIREMENT ,+.+~- ~ n n t <br />1L'G • + !• <br />0 c L _ irk <br />'~ <br />anti' :E <br />L0'-r T. ":V~t_.,. r~ SAMPLE f' ~/ <br />0~~ pppI <br />Q <br />O ~ )l} ~'.'n;.... ..,.1«;.I <br />~ <br />dS7 <br />i ,:~ n l? :n.: ::°y r ;>'[,! MEASUREMENT / <br />Q7 r <br />O /! O ~ / <br />A <br />7~U(7 1 ~ :. PERMIT Hz'N ~?T P°I a`%7CL ~•`•qr/."«- .•t Y:#:±f; s•#r'e~;s !:'::;: <br />~ <br />~.'.,~. <br />V t '~'~ ~•- <br />/~"-. <br />''i`_~U_J•-. G~7-', qT r-_ REQUIREMENT . ,, .. „". <br />,T7. 'l. •] ':c•-" <br />' SAMPLE ;•fi •: ••rtg ( ~1~ .-...f..., ..c ^_::r::;:.::• .,_I; :•:!: r: <br />O <br />~ <br />A( <br />( <br />j5t; ,iL MEASUREMENT 31 / <br />(SU <br />34DEG x U 7 PERMIT .: :y L=gig^. 7 X ';=.. .~>CT•k,••r ,;;v ;v~°.. ~.?~s~: ;~y, ':,': r PCgYZ '? <br />i1 ~• L <br />_ ! L tl' 'P i - ' L'" REQUIREMENT j tl c ~, 1 y n <br />~~_ ~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUTAEMENT <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 />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONMLY E%AMINED MD TELEPHONE DATE <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON <br />tt <br />~~C:1a r~ It'll~~ i MY INDUIIIY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />Elltd~ ';~r <br />ar <br />Ha <br />F <br />' <br />~ TRUE. ACCUMTE MID COMRETE. I AM AWME THAT THERE ME <br />AGNIRCANT PENQTIES FOR SUBMITTING FMSE INFORMATION <br />INCLUDING <br />T <br />D <br />' <br />. <br />g <br />' <br />.V <br />PDT1Z , <br />THE POSSIBILITY OF RNE AND IMPNSONMENT <br />SEE to U <br />S <br />C <br />1 1001 MD 77 ~p <br />y g,0-277 <br />/ 77 7.S v8 <br /> . <br />. <br />. <br />. <br />U <br />S <br />C <br />f 1 S 1 e <br />M4r <br />lM <br />W <br />l <br />I <br />N <br />f 610NATURE OF PRINCIPAL EIEECUTR/E <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />, <br />. <br />u <br />e <br />rw rwRnrr n,rY <br />x <br />,dr <br />ors W ro ! 10,000 <br />rM>mumrn irrplwmwnr alMMwn en,meYr rrN6rwral <br />OFFICER OR AUFHORIZED AGENT <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />a.vmMCrv I a nnv cnr coon ~ wn yr nn • v,vcn I Iona Insrsrrnce an ertecnmenrs nere/ <br />,.,." .r !r1_.~. _r.' _ -., :~ ~;, j'.,, _ ^~.^2~r. a•.~o ;•.~= r_.~ ,rT,I,, n.T-t .• ~_ ,._,,,.. ~,,_ ..- n._ -,n <br />,,: <br />~L~ '7. r-O 1. ?, .~ _Ir `.n" <br />^ _~)?.~- is pn•]1 •' rr;:~j T' ~~ '"'• r]rI - r~ G..__ ~ <br />.. ,r]., ~~~ r nr ~~ <br />'/ <br />I ^r, „ram _~~ • - <br />EPA Form 3320-1 108.951 Prevloue edluone mey be used. IREPLACE6 EPA FORM T-40 WNICH MAY NOT BE USED.I , <br />, <br />~ " ~ _ <br />" .. „ PAGE <br />OF <br /> ~ <br />I ~ <br />~ „I <br />T _ ~ ~ ~ <br />