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PERMITTEE NAME/ADDRESS nnd~b F.clLy Nar/Lecellm dDl])fnnV) <br />NAME TSBflGf; ,:ICi•:CK ~7'?PAif'( <br />ADDRESS TE RNGR CREEii L7AU~~UC <br />18uU HI~NYAY 133 <br />eAORIA cb el4a~ <br />FACILITY <br />LOCATION ~ <br />ATfY: KELLY FRIILLIiR, 7p~:RAIIGNS '73R <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM (NPDESI FOEm Approved. <br />DISCHARGE MONITORING REPOfiT IDMRI • O B o 2040 0,0 - r <br />/1-rel n7-ES) SFDI F~~N;i el TG Y MJ~d ~-~~.~~h <br />CJ.iH5002i GU (SUER :IC) APProvel eX ~i~~o - t-98 <br />PERMIT NUMBER DISCHMOE NUMBER F - ~I NAL <br />MONITORING PERIOD NIAE3R <br />YEAR •.MO ~ DAV YEAR MO DAY <br />FROM TO 300 NC (iISCNARCF. kYX~ •:"'r <br />110-1 /1 / ~ 1 111-151 !26171 118-191 136311 NOTE: Read inetrUCtiorle before completlnp thu form. <br />i PARAMETER I3 brd Onry1 QUAN717Y OR ROADINO II C-rd~On/yl QUANTITY OR CONCENTRATION <br />' NO- FREQUENCY SAMPLE <br /> !16531 151-6/ ~ 146531 151-611 <br />:13HJ51 <br />EX DF <br />l31-371 ANALrsIS TYPE <br /> AVERAGE MAXIMUM UNITS„ ~ " ~ MINIMUM AVERAGE MAXIMUM UNITS mmesl I5q-sgl 1e47o1 <br />GREASE SAMPLE O'><aaa ( q'1) 4x3#R# #a0 3t= ...,.. <br />I S U A L MEASUREMENT <br />4066 1 U J PERMIT :;-~x}t? . : •:&1lP3Bt ES=1 s¢as <br />: <br />.::. >al¢1~i~ # <br />.. #t+aY;=ri r:.:.^: P.;'LY I' U9[. <br />FPLUEYT GRU55 YALJE REQUIREMENT _~ItS:I$:.:AAI N(]=U .. <br />.. <br />. . . r,:;:~r; <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT. <br />.I .. .. .... .. .::.. . <br /> REQUIREMENT: <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~REQUIREMENT€ ~ ~ ~ ~~ ~~ <br /> SAMPLE <br /> MEASUREMENT . <br /> ...PERMIT I. <br /> REQUIREMENTf - <br /> SAMPLE <br /> MEASUREMENT <br /> .~.RERMIT :~.i ~ ~ ~ .. <br /> 'REQU.IREMENT ~ : ~ ~ ~ . <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT .. <br /> :REQUIREMENT. ~ ~. ~ ~ ~~ <br /> SAMPLE . <br /> MEASUREMEN'~ ~ - <br />~~ <br /> PERMIT . ~~ ~~~ ~ ~ <br /> ~REQf11REMENS~. ~~:i, ::. <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I cERTI <br />AM FA FV UNDER PENMTr of <br />MILIM WITH THE INFO uw rNAT I NAVE PERSONMLr EI(AMINED MD <br />RMATION SUBMITTED HEREIN; MD BASED ON ~ TELEPHONE DATE <br /> MY ~INQVIRY OF THOSE INDINOUAL9 IMMEDIATELY RESPONSIBLE FDR <br />OBTAINING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS <br />/ <br />~~ '. <br />T TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />BIGNIFICMT PFNALTIEe FOR SUBMITTNG FALSE INFORMATION <br />INQLUDING ~ <br />/~ <br />I~IIS ~IP4 <br />V[LLY fQITZ LES~O~r Q/~ , <br />/ ~ r, <br />~ 7 C <br />2 B <br />O ~ <br />~' ~ ~, <br /> THE P0591BNTY OF RNE MD IMPRISONMENT. BEE 1e U.S.C. 1 1001 MID 3] <br />N , - <br /> U.S.C. E r]ie. /IYrrRlr. uwM- o1.r mtvpr nvy NrkW riT.~ ~ ro SIO,OgO BIOIIATUR CIPAL EXECUT <br />E A A <br />TYPED OR PRINTED n.enmunw.nLm,.iawwlr olbMwvlemonNa.•M6yra.1 OFFICER RAIRNORRED AGENT CODE HUMEtER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence ell sttechments here/ ' <br />SElfLEAbLi; 57LIrJS LI.SIP APPL$E5 :;.tiLY I'' C= LJ-Yi'., 2U-9R P3E:1P aYEN1' SS CLnIP%I:. IF CLIIR APPRJYEU 9Y <br />MQCU, TSS S IRGN LIKCP:; :LLL NJI 9: RP?LIEU Ta::jlepa@tP.D 'fEASUREtlEtiTS--S E I.H.lA, PG 5 ANU I. 9. 1D, PG 6. <br />STORMYA TP. fi !IGYA,^-CM PYT DE ~N c T_I -OA- ? <br />EPA Form 3320-1 108.961 Pretioue editions mey be used. fREPLACE6 EPA ORM 240 WHICH MAY NOT BE USED.1 ~~ PAGE OF <br />U128/97-Y~.~yk~`-1254 2 . <br />