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PERMITTEE NAME/ADDRESS R.3~d.farlGlrNa/L«mlm I/Dldw..p <br />NAME ,aYN fv. `.r~ l ~ _ ~~.,' ~. :.I ia~ <br />ADDRESS r' L J:. A iu v <br />l.;ta[u ..., dlbt.. <br />FACILTTr I,YPKUS CN[~[Kt ;,i[~.r'UKAT[i:iv <br />LOCATIONI~a [` (,;J ULCZJ <br />,LI[iv N1~nAtl_ w. IUULIiH. L.1 ,+F KAL N, u~l <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT (OMRI <br />714 s1 17.191 <br />PERMIT NUMBER aetNUIGE NuMBm <br />MON 0 9iPER10D <br />YEAR MO D YEAR MO DAY <br />FROM y,; U/ ~'. Q Uy 3Q <br />aozll n1-z3i n4 ns-17e rte-ss7 r3a3t1 <br />Form Approved. <br />OWI9. No. 2040.OQ04 <br />~TipproveL'expirpe'OS-31-~J8 <br />J L._.l .\h t!~Y~. <br />t- ~ 1.\HL <br />?I [ IYUR <br />NOTE: R~sd Irutruotlona beloj comp tlnq th4 loan. <br />PARAMETER I3 r..d only/ QUANTITY OR LOADING / rd onryl ~ UANTITY OR CONCENTRATION ND. FREOUENLY SAMPLE <br /> <br />37( <br />3 d653 5461 (38-sd 4653 6461 OF <br />NUrs <br />e <br />TYPE <br />( <br />1. AVERAGE MAXIMUM UNITS MINIMUM ~ AVERAGE MAXIMUM UNITS ff7.dd/ A <br />l <br />!64661 /69.701 <br />ai [L Air I) .,KE4,~L SAMPLE ,, .r :..; ..;. yp ;. ;<:, ry!t# 4>~>adFi" 4.'#'r Yra <br />Y i~uHL MEASUREMENT <br />~ <br /> <br /> <br />~rU i.O i Li U <br /> <br />~ PfRM1.T <br /> <br />~ #il$9!!F"# <br />~ <br /> <br />t1 _. <br /> <br />]~ <br /> <br />;~;~~~1!?[!ikaX <br />~~. <br /> <br />!">;+#~S"Y<R<. <br /> <br />~ ~ ~~d"#~?[I:?df.~ir:~.':: <br /> <br />4k4 <br /> <br />~: <br /> <br />~Ik~G'~t:l[. <br />.:'E'.:~.~ ~~ <br />'~_J[~AV. <br />Ltf LUL(v[ ~KGy~ VaLU :REQUIREMENT. ~ ~:;.'~[ si X~~~ N- . <br />;'<<S a>~~.;~~i. ~ #44R <br /> SAMPLE <br /> MEASUREMENT <br /> <br />.: <br />~:' ~ <br />: PERMIT <br />. <br />. <br />.:~:.. xii:i'..:'.:.. <br />.., <br />. , <br />: <br />..I <br />,. .. . <br /> . <br />. <br />REQUIREMENT <br />~ ,, <br />r <br />,...: <br />': <br />:. . <br />~ <br />,.~.. <br />' <br /> <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> `~~PERMIT ~" ' <br /> <br />~ <br />.. <br />' <br />' ' <br />' <br /> <br />~ <br />~ <br /> <br />' <br /> <br />~ <br /> 'REQUIREMEN7: '~:r>.;.~.: ~:;~;..:.~•:.:. ~.:..' ~>.... <br />~ : <br />. <br />.:-:. <br />~..~:. .,..~.::.. .:. <br />.. <br />:. <br />~:.',: ~.., ~ .'~. <br />:.... <br />:: .':..:: :~. <br /> <br /> <br />.. <br /> <br />.:~s: <br />: :~r~ <br /> <br />~ <br /> :.. <br />...:....:.,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT.. ~ ..... ....:.. .. <br />~:::' .. <br /> <br />,: . ...:. ,..... .: <br /> .REQUIREMENT ' <br />: <br />.,:. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT'. <br />~ ;::::.: <br />~~ <br /> ~'REQUIREMENT'~ <br />. ~~ <br />,. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT.. ~ ... .. ~ .. .. :: .. ....... <br /> REQULREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .. PERMIT :' .. .:' ... . <br /> .flEQUIRENI,FNT ~ ~ ' ~ .: <br />,..: ~Y <br />.:.:... ....... <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENAITT OF UW TNAT I NAVE PERSONALLY ExAMINED AND TELEPHONE DATE <br /> <br /> <br />'' AM FAMIUAfl WITH THE INFORMATION SUBMITTED NFREIN; AND BASED ON <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />FOR <br />TIO <br />1 BE <br />BMITTED INFORMATION <br />S <br />OBT <br />N <br />T <br />E <br />EV <br />THE <br />~ <br /> <br />1~ <br />icharcl ,t1ills AI <br />ING <br />H <br />IN <br />MA <br />N, <br />SU <br />I <br />LI <br />E <br />T <br /> <br />h? <br />~ <br />i <br />^ NAT TNERE ME <br />TRUE. ACCUMTE AND COM0.ETE. I AM AWARE ~ <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATON <br />INCLUDING i e <br />~97 1570-27[2 <br />IO <br />~ <br />9Q <br />anac;er <br />:nv <br />r <br />IZrlental , <br /> THE POSSIBILITY OF RNE ANO IMFRISONMENT. SEE 76 U.S.C. E 1001 AND» E <br />U <br /> " ~ fO rEO.OOO <br />~ <br />E <br />~ <br />~ <br />~ <br />r <br />~ <br />~ <br />r <br />~ <br />~ eI <br />NATURE OF PRINCIPAL EXECUTIV A A <br />TYPED OR PRINTED nd~, <br />n m <br />.+~n~ <br />iMnr <br />i.n <br />I <br />rw <br />rrs <br />s <br />wr ~, <br />xs <br />e OFFICER OR AUiNOgIZED AOEM <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/srencs s// sttecnmsnts hers/ <br />IL-.~ Lt'~l[ r,r'r'Lic~ it, L, •J11GI.`+tU rLUW FRC~I Uuit O[L .. .;_n. 1[L i. GilEa;E .;~ao`iAhIFLL a..ALYS[5 RU.iu11.~:, lr <br />:i~iJlr ~nttcv !:J U~~cr•YL... ar+[ftLY SAMPLIIVU IiJSi>ZU'~i[~~r,~-I.~.ts~ PG X. <br />EPA Form 3320.1 108-961 Previous editions msy be used. IREPLACEB EPA FORM T30 WHICH MAY NOT BE UBED.1 ' ~ I J I 1 PAGE LOF <br />' JUJ27/'i~[JJi <br />