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PERMRTEE NAME/ADDRESS pwdl4 fsWryN~/lamlw IJDIp .,q NATIONAL POLLUTANT DISCNAAOE ELIMINATION SYSTEM (NPDES) Form Approved. <br />NAy.1E DISCHARGE MONITORING REPORT lOMRI _ . OMB.No. 2040-0004 . <br />- ,! .... .. .. 17-761 I7-791 i 7 • ..~ . , i - .. <br />A4DRE55 ,, ,~ y ~ "I .,~ T ~ ~ , c - :, I -. ,. •, ! I dpprovell ezpiree 05-31-98 <br />~, PERMIT NUMBER DISCHARGE NUMBER _ - ~ T . <br />' ~ ~ ~ MONITORING PERIOD ~ ~~ <br />FACILITY _ <br />LOCATION ' ' - YEAR MO DAY YEAR MO DAV __ <br />FROM 31 ., .•~i TO .1 ~ti ~ ,:- r_ :.. .. :.-. <br />+ • 1161 // 177-13/ !7675! r?E17/ 178-19! x36371 ~ NOTE: Reed InttructlaM bsfori LroTlpleUDp this form. <br />PARAMETER !3 Grd On/y/ QUANTTiY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> !46531 15661 138-151 !4653 !51-51 EX OF TYPE <br />I3Z-371 ANALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS leI331 !84.88/ /84)01 <br />- ~ . SAMPLE :: ~ n !i~ ... .. <br />. .. MEASUREMENT <br /> <br />,y ., ~ <br />.. <br />1 J ~ PERMIT ...~,..~.., ., <br />..,., c'•f <br />r'„;~t}g' ~ :.1 :.'•#O:=': hlt l`#:~'ir 'i'~4f ;=;-:d IE. L'ti :.° t+I `~'-': <br /> REQUIREMENT a <br />L <br />. 7 _r` <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 /> 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 EXECUTNE OFFICER I cERnFV ur+oER PENALTY of <br />AM FAMILIAfl WITH THE INFO uw THAT I NAVE PERSONALLY E%AMINEO AND <br />RMATION SUBMITTED NERDN; AND BASED ON '~ / ~ / <br />~' TELEPHONE DATE <br /> <br />W' i11~ hl I~' ~ ~ <br />I I <br />•'k <br />~' INOUIRr OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />NING THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />OBT / <br /> <br />~ ! ~ <br />i <br />~ ; , <br />N <br />T / <br />' <br />- <br /> HAT THERE ME <br />TRUE, ACCUMTE AND COMPLETE. I AM AWARE <br />TIES FOfl SUBMITTING FQSE INFORMATION <br />INCLUDING <br />90 <br />NT PENA <br />AC ~ <br />~ <br />J ~ <br />/ j L 7c~ r` _ <br />1 <br />~ <br />r ~ 1 , <br />NI <br />A <br />L ~ - <br />J7 <br />J ~ _ <br />l , <br />~ <br />J <br />Y 1 j <br />~ • ~-' Ll <br />' - N * . THE POSSIBRITY OF RNE AND IMPNSONMENT. SEE to U.S.C. f 1001 ANO 33 610NATURE OF R1INGPAL EXECIfTNE ~ ~ ~ ~ ~ <br />~ / <br /> <br />TYPED OR PRINTED U.S.C. f 131 e. lAiWeYA u+Nr ewr moms nIFY N+cAidl rwF W ro i 10,000 <br />n+CamvlrrxAn luMa>mrN OrpFIwANII mr'NaAMeyria.l <br />OFFICER OR AUTHORIZED AGENT <br />CAOEDE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS ANO EXPLANATION Oh ANY VIVLA71VN5 (HI/erence a//ertecnmsn(s oars/ <br />... L: .. 'v:. ~i ~. ,.L ~ 'I: - ..~ ~ .. " - - - r X11 ,.T ~ i ° • ~ .-~ " 1V i ~ r <br />EPA' Fdrli 3320-'1 08-951 P/eNOUe edlElOli9 mqy 6e U6dH. ' ' ' ' ' IREPL'ACE9•EPA FORM T' HICN MAY' NOT BE UBED:) ` ' ' ' ~ ' ' •' PAGE OF <br />