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PERMITTEE NAME/ADDRESS pnoW.Fwa~yNaWLeranw, UDdsnu) <br />NAME ~ , , _ - -- <br />ADDRESS -. ~ . ~ ~ ... ~ ~` <br />)• .• (.. <br />FACILm <br />~- .. _. , <br />LOCATION <br />NATIONAL POLLUTANT dSCXARGE FIIMINAT)OM SYSTEM (NPDESI Form Approved. <br />DISCHARGE MONITORING REPORT /OMRI OMB No. 2040-0004 <br />7-I61 17-19 - <br />- l / Approval expirer OS-31-98 <br />PERMIT NUMBER gSCHARGE NUMBER - , <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY ---- , <br />FROM ~ TO ~ ~ ~ ~ I " " <br />' rsaZr/ vaa31 r~~-asi /I6~71 179-I91 r3a3u NOTE: Raad Inatruedom befoFe eomplatinp thL form. <br />PARAMETER l3 Grd OnN! QUANTITY OR LOADING !4 Qrb OnNI QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> !/6531 5461 /38451 !06-53 (6e-5/ EX TYPE <br />I32-371 ANNY95 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e:-eal !µ5g1 !5&701 <br />.I-~' <br />~' SAMPLE ~ I I <br />(~,I ..,. C) MEASUREMENT -~~~~~C~ - ~ 1~ ~ L /=~~1 C•)r,~ )'. <br />. ~i ... ~, _ (• PERMIT .. .. .-.... :. ~q1 t. - 1S. .;~/ 7'i' <br />_ ;REQUIREMENT <br />~ ~ ~ ". ^.r: i•7~•. "~:P~.i,~l.~,~~ - i• <br />. ~ <br />I~ ., ~. ..~ ~ ~~ SAMPLE <br />MEASUREMENT <br />-Cc:!~'{~~ hh <br />. [r~~u )'7~~'% t ' ~ - ~ .. ., . <br />~~ I <br />~ <br />ill . P. <br />1 .l PERMIT. i. ~ c'. <br />~~~~~! - ':i: ,. <br />~ .::f^,::. ..... - ~. <br />-- ~• ;REQUIREMENT _ ~ -~• ~ <br />"- ~ ~ " <br />_-" - _ <br />r SAMPLE - ~ - - - ~ Z ( ' 1 <br /> <br />MEASUREMENT <br />\ ~~ <br />~ ~- <br />/~J I <br />/iG~lY' <br />~i f i ,. ~~ PERMIT .,.. ~,Y;t.'r.:" -„ ~ ;: oA ?, ~" '~ ~ ~ •). ~. SI%^ ~ ~: I 1 .. ~ % •1 <br />.1 ~ .REQUIREMENT - ~? is 3 7 Y . <br />Sd~ ..Y ~ j~~"i.r r"..~ " e ~ <br />..: I <br /> SAMPLE <br /> MEASUREMENT ~ <br /> ~. PERMIT. - <br /> REQUIREMENT ~ ~ ~ ~ - - <br /> SAMPLE <br /> MEASUREMENT <br /> "~PERMIT~ ~~ ~ <br />~ ~ - ~ ." ~ <br />~ ~ <br />~ <br />~ . <br />.~. ~ <br /> REQUIREMENT ~ ~. " - ~ - .. ~ . ~... . <br /> SAMPLE <br />I~ MEASUREMENT <br />- PERMIT <br /> REQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ " <br /> REQUIREMENT <br />NAME/71TLE PRINCIPAL EXECUTNE OFFICER I cERnFV unou PENALTY OF <br />AM FAMILIAR WITH THE INFO LwW TNAT I NAVE vERSDNAUr E%AMINED AND <br />RMATION SUBMITTED NERDH; AND aASED ON - / % ~ TELEPHONE DATE <br />I :l_ I•) <br />7~ '~ I I` h - ' ~- <br />- MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONABLE FOR <br />I BOJEVE THE SUBMITTED INFORMATION IS <br />OBTNNING THE INFOIUAADON ~ <br />/ /-, <br />' <br />, , <br />TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT TNFRE ARE <br />INCLUDING <br />ONIRCANT PENNTIES FOR SUBMITTING FALSE INFORMATION <br />S r ~ ~ / <br />~ ~) i <br />~ <br /> <br />rt <br />~ <br />' ~ , <br />I <br />~ _ <br />! <br />1 ! <br />~ I <br />I <br />i t THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE )6 U.S.C. E )001 AND 31 SIGNATURE OF IRINCMAL EXECI7TIVE r ~ ~ <br />'~ l <br /> ~ ~ ~s rp ro F )0.000 <br />~ <br />~a <br />~ <br />v~ <br />M <br />N <br />TYPED OR PRINTED rN <br />i <br />TAVAI <br />Aral w mu <br />S.e Mw/ <br />inFrr <br />M <br />6 OFFlCER OR AUTNORQED AOENi CODE NUMBER YEAR MO ppY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRdsrsnn ell er/schments hare! <br />.~I .. ~ ~ - .._. :F <br />EPA Form 3320.7 (08-96) Previous editions may be used. (REPLACES EDA FORM T40 WHICH MAY NOT BE UbED.I ~ _ PAGE OF <br />