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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 />