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PERMITTEE NAME/ADDRESS p.eL/. FsWryNr'LOrmm rlDylrnv) <br />NAME THA :, EI F. 't *IYT u~'1 . T,, ,", <br />ADDRESS T ~' )+ ~ l' F' ~{ 1 ', V E <br /> <br />CNAi~ ~) ~+1)~,/h <br />FAal.m <br />', LOCATION <br />ATTfI: .:nP ~~u of•TC Cr^- <br />P': -S/ ~ .~r <br /> F <br /> PARAMETER 13 Grd Onlyl GUANTI <br /> 146-531 <br /> l32~T71 <br /> AVERAGE <br /> OIL A:/l' :;~;A SF. SAMPLE . .:..^.G" <br /> V I SC A L MEASUREMENT <br />4 d4l)6G 1 ri <br />. .PERMIT. ~ <br />^,;. ~C~~,'}: (t ~: <br /> ;PPLU ~. (iT ,. ".7i5 C.iL%,' ~REQUIREMENT ~ .. ?~~ <br />~ ~-- <br />NATIONAL POLLUTMT DISCHMOE ELIMINATION 4yaTEM (NPOESI form Approved. <br />DISCHARGE MONITORING REPORT /DMRI ~, T v „ ~ OMB No. 2040-0004 <br />/?-18/ l17-/91 - <br />"' ~ ~ ~ l 5 n (~ II ~-- r •; F1 APProvel exgrea OS-31-98 ' <br />PERMIT NUMBER DISCHMGE NUMBER r _ ..- T ./ A . ~ ~ .. ~ ; <br />MONITORING PERIOD I <br />YEAR MO DAY YEAR MO DAY <br />FROM TO .;: _^- t~~ rr ... ,.y AD^~' ~_~~ ~I: = i <br />r2iriii i<7-73i iiF?5) ;7e2?: (28.29,1 13431/ `NOTE: goad Irotruetlom bafon eomplatiny thin form. <br />TY OR LOADING l4 Ord OnlW GUANTITY OR CONCENTRATION ND FREOUENM SAMPLE I+ <br />/5b8r/ (38..151 /a653/ l5L81 OF ~' <br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s~ sal l~eBl 169-70/ 1i <br /> D 7 Yit~i <br />REPDRt P.S=1 atia~t>atw.:: i;::.:.r~>~r.« -:'Y.~R;kis.+FS.. '`•~"• E:~:it:L.'i .:L4tTA4 <br /> <br />~REOUIREMENT ~~~ ~~:~ <br />NAME/TITLE PRINCIPAL EXECIflNE OFFICER I OERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD ~ ~ ~ TELEPHONE DATE <br />i AM FAMILIM WITH THE INFORMATION SUBMITTED HERflM; MD EASED ON <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONAlLE FOR // <br />Id. ' • '~'.IJ.1 UPC•-'Ii OBTNNINO THE INFORMATION, I eEIIEVE THE SUBMITTED INFORMATION IS ~~C ~ ~'~ `? ~ -~8 ~G-~44'1'•. ~9 lU 2 <br />TRUE, ACCURATE AND COMPLETE. I AM AWME THAT THERE ME <br />F{ ~.~ J~' [ ~G2^01-3.1 :i3 R3jjE:{ SGNIRCANT PENALTIES FOP SUBMITTING FKSE INFORMATION, INCLUDING <br />THE POSS191LITY OF FWE AND IMRaSONMENT. SEE to U.S.C. ! 1001 MD 31 <br />U.S.C. f 1710. lMMRi.. utlr ewAr mnm. my irJW riw. Ip m J IO,OpO SNINATIXIE OF PRINCNAL EXECUTNE AREA <br />TYPED OR PRINTED ra a-muhlvn triplswnx W Mtrwn s montlnW 6 ywAl OFFlCER OR AUTHOPI2ED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRa/eranca sll athchman(s hare) <br />T5: ,, r,J; AL i4U-, E.I"IT3 Y'71. 1. 'I .: d?;7°~J~ 94D 5!'T^`LFA9L~ S:7LTf1': !.7'!`.".r R?PT.T^D "lv l~'~II Ip o-P(•Tn r•V"~l*- <br />/ i"F: '1 i;"' "y 7P D12DOF R£)UTzIFi?.`:TS •: ~, r•BR C. A.3. DE?'lITTFE PS 175T '1'4•T~ ~'..L oF'p ^n,.•.• r - .rn R'', I`pC'r <br />y - • ^v nr T rT i•- T q <br />cee, e_..~ +020.1 108-961 PreV10Ua editiam maV be used. (REPLACES EPA FORM T-40 WH(C -MAY OT BE USED.) n n ~ ~ ~ , ., ., ,.., , , _ , ,~ t 1, PAGE ~OF) <br />1 ~. <br />