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<br />PERMITIEE NAMEJADDRESS (lrir6 FrWryN../Localm I/Dlf rrN) NATIGMILL POLLUTANT GISCNMGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />NAME <br />EA~iSIDF <br />JAL 77'1PAiYF <br />I4;;. DISCHARGE MONTTORING REPORT (OMRI <br />r7-E5J J7-JSJ <br />I°jiI F'?VD 1 '-.? OM Nn. 2040-OOS14 <br />Nnp <br />~ <br />~lai°i <br />5°31 <br />98% <br />a <br />ADDRESS ~,$'il.ilDE 4INF "^^P ~ ~ ~~ ~ (sueR vc~ P <br />o <br />- <br />r <br />e <br />RECE-I~/~E~ <br />P. 0. B i d 1 ;1 l U J/ PERMIT NUMBER DISCHARGE HUMBER F- F I i A L ~ <br />SAh ANI]'! <br />FACILITY IJ rX 7927)-1JU7 <br /> <br />^ E <br />MONITORING PERIOD <br />.`! I! 0 R ' <br /> <br />11 Z~U1 <br />EASTSI7`: ~7A! 771uANY, I9 <br />_. YEAR MO DAV YEAR MO DAY/ ~ <br />LocnnoNSILr CD U15~2 FROM 71 4U 7L TG „~ Uu-' 3 ~hY N•1 'IL~CHARC . j -~as <br />A r L N : S C !.' J K E: N 5 F !. F - - r' ti ^ F! A !. +f A .v A .'; ^ 3 120.111 /77-731 !7475/ (26-?71 128-791 I3a3]1 NOTE: steed InetrucdoFle belorktin~ tl~e~or~l ~ <br />4 <br />PARAMETER 13 Grd Onlyl QUANTRY OR LOADING l4 Grd On/yl QUANTI O CONCENTRATION ND. FREOVENCY SAMPLE <br /> ld5-531 1546/1 l3B-151 d5- 3 !54611 EX OF <br />l3Z-371 ANAivss TYPE <br /> . AVERAGE MAXIMUM UNITS MINIMUM A~E~ GE MAXIMUM UNITS re7-asl !54551 r5.9-701 <br />"t1 SAMPLE !.`•Rrx:k tF'?:RR~Y ~ J -?: ( 7.?( <br />1 MEASUREMENT <br />UU4JD 1 D D ,~ PERMIT {:RC RL .• ¢R;;R'x is t ### 5, 5 ~zl ::# /'» <br />9 D ~ a <br />I„EKLY c <br />IN~IrC <br />EF FLUf.:ir ~R755 VA iI~ REQUIREMENT - 4a#C Tu: +~x rs vrM Fr crr <br />SOLIDS, SeICLEA~iLt: SAMPLE ,-fRRR¢ ~>n;:XRC p;;v`.:L-:F `# :¢ ( 25) <br /> MEASUREMENT <br />UUSVS 1 0 D PERMIT ;r3r: RR'Y R3rxRiR ~: #¢-R :Yk#=x ;. ~ ~3¢ U. S. NCa/ :RAB <br />cFFL`ltlii 7R73i PAL!! REQUIREMENT tvda t. rr Jr *rry~lu <br />:JIL ANU ,.iLAiF, SAMPLE ¢;: R;r krx RrRRS'.r R^r ;-r+:~~ G¢ ~# ( 19i <br /> MEASUREMENT <br />U35dZ 1 U J PERMIT ;.¢R<t?6 ff¢#¢#3 K #'<"• #IDOrL':x::: :: R7pi #:. 14 <br />~ <br />~,Q ~ T I Y < <br />' R A %. <br />EFFLUENT ;;P.7i; VALUE REQUIREMENT <br />. ¢;x•a nnT MY Nr•J -.r i• <br />FLON, IN ,:7YOrIIT 74 SAMPLE ( U3) R;c ;a i::;:;: ¢¢ #¢ .::"Sr <br />TBRU rRLAr^+ENr PLA~7[ MEASUREMENT <br />SOUSD 1 J U PERMIT OPTI)NAL RE?OEI xRrRR;: ;=r a A#azr <br />~ :r::c:s tEEiiLY r <br />`+SIA'~ <br />EPPLUi•:'iI ufi7`.`-i YAL'Jf REQUIREMENT ID 5 V: A A Cf) ~" {-".^.vc . <br />. <br />SOLIDS, r.JiAL SAMPLE y;:;,„ R;;r;r~~ ~;;Fi<.F~f_ #'i ( 1^) <br />UI35OLY..O MEASUAEMENT <br />-10295 1 D J PERMIT :~#xttaR R#~;<pt a #-xh R#"vR'Y,~ z: ir# ~ R£P~RT ~ IT~iLY ;RAc <br />E:FFLUENi ;;ROSS VALUE REQUIREMENT #¢RR RATt V MY Kr r <br />OIL ANU „:iCASE SAMPLE ¢:=tlE~xRR ( 94~ ::s:::,_ -a::= 'h4 v,-:!+~ <br />Y IS U AL MEASUREMENT <br />34Jo6 I D 0 PERMIT '~¢9 R^: ~: RL?ORT E`i=1 G'$R+F'r"i%: K: •R¢ # :r##¢Xr %= :#a;:C I ;.%~F;/ (T:,D?. ', <br />CF'fLUENT .;R)i3 YAL'JE REQUIREMENT jN5 !! s=0 u~rL• <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PEMKTY OF UW THAT 1 HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />~ TELEPHONE DATE <br /> <br /> <br />p Q(, <br />// ~ // <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION <br />I BEl1EVE THE SUBMITTED INFORMATION IS / <br />' <br />/' ' <br />// <br />~ <br /> <br />/ , <br />TRUE. ACCUMTE AMD COMPLETE. I AM AWME TNAT iNERE ME <br />9GNIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ ~~ `//, <br />~1 ~~/ /~ <br />C <br />~J <br />_ _ ~ <br />L .` _ /' <br />f/ d/ G//~/A'EJ , <br />THE P055181LITV OF FINE AND IMPWSONMENT. SEE 18 U.S.C. r 1001 MID 9i ~,1~, ~ _ <br />L' BIUNATUIIE OF PEiINgPAL EXECIJNVE z/,I <br />V ~ <br />u- A <br />7 Y~ ~, ~ 7 <br />~f <br /> /"~ ~~ `° ro JroaaD <br />S <br />O <br />~ <br />:s <br />:; <br />~ <br />: <br />~ <br />~ <br />' <br />~ <br />; <br />D <br />' ~y AREA <br />TYPED OR PRINTED O <br />S <br />;~ <br />. <br />~. <br />~ <br />,orl,n.n <br />w <br />. <br />, <br />~,, <br />,e <br />,, <br />,w <br />y.asl <br />. <br />OFRCER OR AUTHORIZED AGENT <br />CODE <br />NUMBER YEAR MO DAV <br />COMMENTS AND EA.YLANAIION Of ANY VIOLA I IVNS lfrl/erence e// stteC/ImentS RNs/ <br />:,3TLLEdULii 57LIDS LIwIr i(AIV°O P7.t LD-C9, 27-NR PR-:CIP EYFh: ~U~JEC'r Tn U9~!C°ti OF ??OOF' DgnrTrRgycNTg i. f~ <br />rPdr I.i:.1.J, ?;. 5. STOdlaAT~R 1A7p;,FyF.NI 'LAN P'1F 1-L-9u. <br />1 EPA Form 3320-1 108-951 PrevlGUe editlone may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED./ PgGE OF <br />y U276/97JU1"-1535 1 <br />