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J <br />r <br />PERMITTEE NAME/ADDRESS lI,.rYiFaiaryNsWlocYlan UDIEbwu) <br />NAME :.: ~ 'f j. ' L T , <br />ADDRESS '_'~l? T .: .. ~' 1 - i'. '. ' <br />FACILITY _ ~, _ . <br />~ ~_ .. .. r <br />LOCATION <br />e .7 <br />f,:' <br />NATIONAL POLLVTMT DISCHARGE QIMINADON BYSTEM NPOESI / rL'::, .tjTi~= r ._. <br />DLSCHARGE MONITORING REPORT - .. 8 .2040-0004 <br />Approval el¢irsB 05-31' 98 <br />^f-.'1 `.lT :; -•-~ ~: i'. inn :') <br />PERMIT NUMBER DISCHMOE NUMBER ~ , <br />'~' <br />MONITORING PERIOD ~ ~ ~'I~ <br />YEAR MO DAY YEAR MO DAY __ <br />FROM Ali ,q ..,1 TO „ ., T ::~,. ._ I y._.. ,,, I I ._ <br />lzo-171 /zz-131 /14151 /16171 r16z91 !30.311 ~~NOTE: Resd imWCUan belore oompleUnp tllie form. <br />PARAMETER 13 GN Onhl GUANTRY OR LOADING lI Grd Onh1 GUANTIIY OR CONCENTRATION Np, HIEGUENCY SAMPLE <br /> (46531 !5/-61 /3BJ51 14663 IW-6f <br />EX OF <br />TYPE <br />(3z-371 MALYSS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lsz.e31 /54881 16x701 <br />' ' .. A ! <br /> <br />~~ ~ • SAMPLE ~:.q •. _.. - n ~f r ( <br /> <br />' <br />~ <br />I I ~ ~ ( 1) <br />I <br />/ <br /> <br />( <br />'J r <br />i <br />.1 MEASUREMENT Jn ~ IJ. -1 , <br />~ r ~ (p , q, ~ <br />. <br />. <br />,. , <br />,. .. 7 ~ PERMIT ,: 1<J}>',='.`• '.S~-7i~ = ., rY;g:;=S::.p;:' 3 t?. ~.r~ R.. ~, ~ -•I `i ~1 <br />;, - . e r <br />. REQUIREMENT ~ _ ~ C ~ M~, . ~ ~n~ 1 r <br />. i:ONPU~[T -, .. SAMPLE .)3) <br />( .. i-. .. .. .. '` % , <br />'iT •~(y- <br />~: iTMY <br />. : EAQUREMENT .I7I7 j~'~, <br />~ • D( ~n~' V 7 T'•, <br />. <br />, . ~ <br />~:, _ L ` ?". PERM77 3.'J1$~ ?t ~'f*:~'R.'C Y~YFrFC'G j}. ~=i=k,'~~.#+'l ek~.. ~ .+s..h. ~:~:t~i P. F'1CL i•i 3•r, <br />„ L <br />'N 5` EQUIREMENT ri ~ ~ _ <br />- <br />I :., .. SAMPLE r to :S::a ::a 'c •^- ~:_.};: ~ ~:: <br />' <br />~{ ~ L MEASUREMENT ~ ~ J / 7 ~ <br />, . ~.,y 1 ~ PERMIT ,. ;: t; t,: g; :$ ~c.~::a,: ;a=e:;.;T a:: ~:rp ~) A~C)~?~. ,t! .'t ";: / ~`'", :'t <br />"t " ~i =, i • ~ EQUIREMENT ~ ~ n-} . V. T.~ .-~... t.l. , •.I, <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 cERnFr uaDER PENALTY of <br />AM FAMIUM WITH THE INFO LAW THAT 1 NAVE PRISONAUr EzAMINEO AHD <br />RMATON SUBMITTED HEREIN: MD BASED ON .' i <br />' <br />' TELEPHONE DATE <br />~ • / <br />V `J, ~ I l ~ YTl ;1 <br />1 I! <br />~Q <br />L ~ MY INQUIRY OF THOSE INDMOUALS IMMEDIATELY RESPONSIBLE FOR <br />I BELIEVE THE 6UBMITTED INFORMATION 19 <br />OBTNNING THE INFORMATION ~ %. <br />- <br />~ / <br />~ <br />, <br />. <br />f <br />- , <br />TRUE, ACCVRATE MD COMRETE. I AM AWME TNAT THERE ME <br />TIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />IF <br />NT PEN . <br />, / <br />~ ~: / ,:\ , <br />`~ <br />- ., <br />`/ ~ <br />Y ~ ~ % - 4 ~ ! YY' w ~~ <br />I 1 ~ , <br />SIGN <br />ICA <br />AL <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. f 1001 AND 33 1 / . / <br />81ONATIRE OF PIIINCIPAL EXECUTIVE <br />~ ~ <br />- ~~ ~ <br />/ / - <br />r I r <br />/ 7 <br /> U.S.C. 1 131 e. !I°Y=vlWr I/Il.r IMF mnma nlrY hclW. IYMa =p ro f 10.000 <br />E <br />TYPED OR PRINTED .ntlwm.rMurt MlplrorvrlrrMbw,.n envntlla.nOB WA'al OFFICER OR AUTHORRED AGENT CODE NUMB <br />R YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLAnONS !/rerennce sN enscnmenrs nerel <br /> <br />EPAj lrorm 9920-t (08.951 Previous editions may be used. (REPLACES EPA FORM TJ10 WHICH MAY NOT BE USED.) PAGE OF <br />