PERMITTEE NAME/ADDRESS 0«6/. F«a1ryN4./mrano. yDlp..wp
<br />NAME •J ~`'. ~1~ ~ __ .._ .-
<br />ADDRESS " ~ ~ - , ~ , ~ ~ ~ Y
<br />I ~
<br />FACILITY
<br />LOCATION
<br />NATIONK POLLUTMT DISCNMGE ELIMINATION SYSTEM INPDESI ~ Form Approved.
<br />DISCHARGE MONITORING REPORT IOMRI
<br />lT-161 /E7-191 °"'~ "' Y n^+I '-. s ~ OMB-No. 2040-0004,
<br />'; "? <' T ~ - 1 D'7 ] ~ (.- n ., ^ ,:. • T ~ ApProvay~explree 05-31-98
<br />'PERMIT NUMBER DISCNMGE NUMBER r• _ ~ r .~ ; 1
<br />,. T.,n
<br />MONITORING PERIOD -
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ + 111 TO ' I . .~ .. „ F , . I 1
<br />116211 !TT-T3/ III-151 176771 !Te-291 !343/1 NOTE: Reed Inetructiorn before eomplelinp !hie form.
<br />PARAMETER l3 Grd OnlYl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> 146531 !546/1 38-151 !1653 (5451! DF
<br />137-371 EX
<br />MKVSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS le]-e]1 (54551 /59-701
<br />-^~~.t fiUCTi PTO SAMPLE ... ., .. ..°. - ~ it o3 7TH)
<br />2!' f 'T1 ~~I
<br />
<br />MEASUREMENT -
<br />7
<br />/ 1 ~ ~)q
<br />~ I KH r7
<br />i !'194 ! PERMIT ^...~ ~r#t,=tx,.. ~ ~ '... ,..f •'.=.". Fy45 vnnT ~,..~•-/ 'y:?ca/ ~+~
<br />°LUB*!'," .,-- Va ~qF REQUIREMENT :',•-7
<br />r T!1fl4 AS'C ~
<br />g
<br />T•r '.+S' ~17t.,'..'
<br />i SAMPLE
<br />MEASUREMENT #'.`-,~hF# C:`.CQA` ~ n
<br />`~ ..... ~' /
<br />I
<br />•]
<br />'I G, ~ ~ ~~ r 1i' ~I~(~l~
<br /> . l. 7
<br />U411U 1 (' D PERMIT <_~°~.`•::Y ####C.# C 't:`•x (T.S ~ ##40~T'- ').^ f 'EEt LY ;?r'
<br />"LCEHT :; `~ `'~:; YALUF REQUIREMENT ~ ~ ?#5 r: '1L "j.lIITT! r~iXl•"7N '''I
<br />_.',i D:i, Tp'! T, [. SAMPLE '.: r: ~•i:}.: ?3•:Y;'='r >Kr#9:# la~\ NA ( ? 41 ~JD, NA N/t
<br />_ i' c g p o p MEASUREMENT
<br />:D:-1J O U U PERMIT #G#r.':;: :=#:Y.;(<rt a C'.:; 'kt~#2=="•, n^^1-`• it^r, ^,;.,T 'tdFE~ :9"- -
<br />;'::~ CON^1ENY5 "~ REQUIREMENT ;; y.
<br />~~~
<br />~ ri:~.'j ~7F+A AV'• •••rSY }t'{ -./T, .'l lli$
<br />i :LI DS, TU7dL SAMPLE #P f=•: P#`. !p#:b ~, r,:-:••:r•'; •- +~n1F
<br />IVY ~r P
<br />~ / I
<br />1 ~ I.
<br />~ X
<br />~
<br />i
<br />I
<br />;PEADF
<br />D MEASUREMENT } ~5 ~ l~A
<br />.
<br />.
<br />.
<br />1l_.'. r? L 0 PEARM`IT ai^. {e:fi #R~'.'.. -. ;t: •v ,.w#.p.-., ..
<br />~ .1 ,. r:l.
<br />'r'~
<br />tR 4:
<br />-.7°tiT ter.,,- p•LU? REnUIR~MENT Ca ': .v .. .{ .
<br />..s1DS, - •'.'.; '1L' SAMPLE
<br />E
<br />E .. •c: ;e r< .. wr: r,•.*::: PJ A N A ~
<br />I ~`' /" fv' (~ N A
<br /> M
<br />ASUREM
<br />NT
<br />~JI15 !J ~.' PERMIT :F:YR ~Z;Br rf F"~t M'= f•-':~ :~'O rY:rtr: nv P[~.n+ :1 ~>i ..-: ..~ ;~,
<br />~.~: CC;M"•'.^i. ~r,~'~ REQUIREMENT ,. •
<br />~Qr1A AB^ r '7
<br />1J1?; 'r/- `;^.
<br />'
<br /> . , :~
<br />_-.. .i ':, i'. '" LYf,9l,' SAMPLE ;c-;: •: C:;: ,i .w .,.R: .:: ,.-.:.::. /
<br />
<br />D
<br />~
<br />F
<br /><
<br />rc
<br />t ~ } _
<br />1
<br />,
<br /> MEASUREMENT `
<br />. O, / ( I ~1 ~
<br />' ; 1~7=~J
<br />, ~;S ? 7 ~ PERMIT "-a60'F~ .'e C+#:+Ss Yc ~r.~w::;: Rt: P:^, s#~e ncr }: ,. „/ .:~ .4.~
<br />- ":.U `'VT ~,P? ~" l':I. :' REQUIREMENT .. 7!'.71 0~.^, r,Erty T
<br />;/. 1.;
<br />_ , .. d I.. , - .''. a `i c SAMPLE ~ ...: .. ... :,_:.,..~ ...- / r1
<br />:) N E;(T?-': n : '/ ~. MEASUREMENT N ~ ~N, r~~; ~. N;~.
<br />'~'>>~b l !3
<br />^ PERMIT .'.::r ;:'; ~, riE';: riT{` .. .:.fi.pf. ,'<~c t.,. h r, ~,.: .,~.,
<br />s
<br />l
<br />'l,4EN? .. ~ ~~
<br />i' L~'.
<br />_ REQUIREMENT .. Tn:~ r. ~~. ;I. ,
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PEMKTY OF LAW THAT I HAVE PERSONKLY E%AMINED MO
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN
<br />MD BASED ON
<br />-"'. TELEPHONE DATE
<br /> ;
<br />MV
<br />IgV OF T ~
<br />/
<br />
<br />!~I CI'81'l~ ~. INGU
<br />HOSE INDIVIDUKS IMMEDIATELY gESPONSIBLE FOq
<br />OBTNNINO THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS /
<br />.,
<br />~
<br />~
<br />~
<br />~
<br />/
<br />_ TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME I I'~~
<br />,
<br />-'
<br />(~
<br />~~'
<br />/
<br />~
<br />`f`; ~~ ' ~ ~ T 'f'nl-
<br />l\ IYE SIGNIFICMT PENKTIES FOR SUBMITTING FKSE INFORMATION
<br />INCLUDING ~
<br />/
<br />.
<br />` .
<br />THE POSSIBILITY OF RNE MD IMPIeSONMENT. SEE 1B U.S.C. E 1001 MD 3]
<br />U
<br />S
<br />f 1 ]10
<br />lAwWS, IwIIY ews mnm
<br />C
<br />r
<br />MAN
<br />t 10
<br />000
<br />SIGNATURE OF PIIINdPAL E%ECUTNE C-!' - (' _ ~ °. ~': ~ ~~ ^
<br />
<br />TYPED OR PRINTED .
<br />.
<br />.
<br />.
<br />, n„Y
<br />,
<br />xw, ~ ro
<br />,
<br />,nd orm„murrhwirwnwte/Mr,.«n enNnN,eM SY„r+l
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />ODMM[N I5 ANU tAr'LANA I IUN Vr' ANT VIVLA I vulva IROrBFBOCe e0 er(eCDTBD is Aerq
<br />r
<br />L:' krd ,a T.: r. - - °G. '. ~ ._ 4'L. -;LTA.. rL.T~ riF) Ly nr.v i~ ~_ I~_',- ~. .-.ter., ~-, -.
<br />". .. "!r.~e ?. ...t ... I.+, 9-`p i4•!'V ,7C :f o^, ~IT^ .~ .., ~ 'If' .~..r~ -_•. r. _.n.-•~ v~^ ., -.
<br />r
<br />EPA Form 3320-1 108-95) Previous editions mey be uaed. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 n ~ ~T ., /„ ~ , ^ 7-,~ ,,I I ~ PAGE , OF
<br />
|