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PERMITfEE NAME/ADDRESS pnrLd. F:Uiryrvow/lx.nm yDrQGn.U <br />NAME' ~YN.cI,~ ~?:r'1~1~ i.Ul~,r',.1t:iiIUI+ <br />ADpRE55 h' ~ uLX iJ .1 <br />CKA1~ ~~ b1bLb <br />FACILITY i.Yr'nu~ ~?'ll-'1PoL. ~,-.:~NUKkT1L:• <br />LOCATION 1, n A (~ U _ ~ . ` , ~ <br />:.TTiv H11-h1Q: L rl. r~riL ll . .h .'ir nAl <br />NATIONAL POLLUTANT DIgCHMOE EUMIHATION SYSTEM fIVPDE$) <br />DISCHARGE MONITORING REPORT (OMR) <br />2-16 17-191 <br />Y <br />PERMIT NUMBER DISCHMOE NUMSER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAY <br />FROM < 9 ~] TO ~ 9 a U 9 3l/ <br />/2 31 116251 /26-27! (28-291 190-911 <br />FortRRh,.NA~pproved. <br />~F l:I r.~ ,. 7~ n~OML-17i"1204~10006 <br />/fpprove~ expuee OSf-31-98 <br />~L ~•ti ~V.i ALj47 <br />F - F1uNL <br />T': 1fr (fin <br />~~ NOTE: Reed If»VVC1{om before m NEinp this form. <br />PARAMETER I3 Ard On/yl QUANTITY OR LOA II 4/JOnlyl QUANTITY OR CONCENTRATION ND FREOUENCV SAMPLE <br /> /46-53 5i6/ ~ f38-l6 16-53 6F61 of <br />f32-371 EX µ <br />LLYAy TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS fs2d2l , <br />f6~-661 f69-701 <br />~~L lust TOTAL SAMPLE ;~>/.},•.; ~~. ;..y /f.. ;~:. IkA###'I< 1'A <br />~ l» i.L y L u MEASUREMENT <br />iL,~~~'J 1 G U .:PERMIT ~ #,y##~,} Afi$##6` s•bi• .?Fi#+~I;~yrF.. 1•;~~P~IIiZ:~:::::~~ <br />~ SJ~~ <br />jiJ~TSi.AI.... ~T,~K~f <br />:Y IiA,`3 <br /> <br />art LUL.rT GKL7~S VALUE REQUIREMENT <br />ai.,}~. <br /> <br />•, ~ ~ <br />~ <br />•~, .•<. (: . <br />H . <br /> SAMPLE <br /> MEASUREMENT <br /> ., ~ .PERMIT ~. ~~ <;:;:: ...'%~~y.,!;; t <br />~ ~:.. . ;. <br /> RECSUIHEMENT ~ ?"i~:.;:~::. :;;i:k~:::~.'::r~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> .PE, MIT <br />::,- <br />~ ..~;`~';:. ~:;; <br /> <br />~ ~ . <br /> .REQUTAEMEN7: ~ ~..:~: :.:.'. ....~ . <br /> SAMPLE <br /> MEASUREMENT <br />~ ' <br /> .. pERMIT.~ ~ ~ ~ . ~ ~. <br /> <br />~ <br /> <br />~ ..::: ~. <br />i <br />~ •~ . ..:: <br />IY:: .: '.. ..' <br /> <br />~ <br />r <br /> <br />~ <br />~ <br /> EQUIRE <br />MENT <br />~R ~ ~: . .. ..,.,.: _... . <br />,...: t :. <br />. <br /> . <br />. <br /> SAMPLE <br /> MEASUREMENT <br />, <br /> PERMIT. ~ :. <br />::: ., :.:.:. .. .. <br />:. . <br />.' <br />t: .: <br /> <br />:.• <br /> . <br />REQU.IREMENT~~ <br />~ ~ ~ •z:.. <br />~:~;~~.: .., .. :. <br />.<;:... ~. <br /> <br />:.....,; <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> .. PERMIT . ~.: : . ~ ., .. ... . <br /> ~REQUIREMENT~ <br /> SAMPLE <br /> MEASUREMENT <br /> .....PERMIT" ~ ~ ~~~.::..x.., .,:,.. <br /> REQULREMENT' .. ~ .:.:.. ... ~ ... .. ~ ~ ~. ~ . ~ . <br /> . <br />~ <br />~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW.THAT I NAVE PERSO <br />AM FAMILIM WITH TNF INFORMATION SUSMIT7E0 H NALLY EI(AMINED MD <br />EREIN <br />MD BASED ON TELEPHONE DATE <br /> MY INQUIRY Of THOSE 7NDIVIDUAL9 IMMEDIATEL <br />DBTNNINO THE INFORMATION <br />i eEUtvE THE SUBMI ; <br />Y RESPON9slE FOR <br />TTED INFORMATION IS <br /> <br />/ <br />'J <br />F'.IC h7 YCI I:11 ~~5 , p. <br />~ <br />' <br />- TRUE. ACCUMTE AND COMRETE. I AM AWM <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFO E TNAT THERE ME <br />RMATION <br />INCLUDING / L <br />- 1 ~J 9~ <br />f.:,V ll <br />O r`r <br />~n tal M1i~r'Td~;BI , I <br />~~ a~~-27~ e. D <br />~. THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 1B U.S.C. 1 1001 AND 9J IPA <br />EXECUTME <br />iIONAT <br />R <br />F <br />RIN <br /> D <br />s';' <br />; <br />'7~ lhwvF• ulw ».r mmn• m.r ~A,w n,.• ro ro tlo,ooe P <br />C <br />E O <br />L <br />U <br />TYPED OR PRINTED ,~ <br />, <br />, <br />, <br />inPrl..ItnNIr.IMM.A.smano). ArN SY..Ye) OFFlCER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />wmmcn I a nnu cwrlnnw I Iun ur wn T vwLn I was armm~ce en err~enmenra here/ <br />.,L.ITLC.+oLC ~-Ir_il;~ L1,•IlI .,AIv~G Fuk l0YKF14rirC P~cG(,li' .rc'~T'SEE I.A.ir P~ lV, F,.< nt,.ulr.'~M_,•T~. tJIL G <br />.,n~p~L unab ~AM~`LL dNALY~l~ Kc,UI~<tU IF VISIdLt ~rictn I~ Lo.icnVcu. 1nTnLY SAMrLI~.v lf~jTKU~TIuryrI.t..ol <br />v. <br />EPA Form 3320-1 108-96) Prsvioue sdihione mey be used. (REPLACES EPA FORM T30 WHICH MAY NOT BE U6ED.1 U L7 U 7 ~ / y U ] U U 1- L 311 PACE 1 F <br />