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PERMITTEE NAMEIADDRESS pnrLL FrdiryNawdLxrtlm (/DlJlrirwr0 NAME tYYROS t:'r,ihC 1...•.:'.:rgl lL:ti ADDRESS N• U dLX bd ' cratL, cG clF2~. ~. . FACILITY Lyr-,U:. Li 6'ir_ "_„nr.~'KI lI.N LOCATION `.~;, L,~ LLJ vl LL7 .ITI:. ~1L,n AtL .:. LLr I)LLi.. vL'aLKhL iS ~,< NATIONAL POLLUTMT DISCHMOE EILMINATON YYSTflA ,,NPDESI . DISCH1 R6 E MONRORINO REPORT lOM91 e - PERMIT NUMBER DISCHMOE NUMBER MONITORING PERIOD YEAR ~ MO DAY YEAR MO DAY FROM ~ ~ y ~ TO ". lI01/1 31 l1L261 !26771 lt9-191 (363/) Form Approved. iv F: i~t o Vii.--?1:! i._ ONlB Mo: 2040.0004 . A~pprovef expires 05-31-SS r - r 1.~AL a L...- iYL .L i:; 1, n..iv`. NOTE: Reed Irntruetlale befon7compl Inp thle fwm. PARAMETER !3 Qrd Onlv1 QUANTITY OR LOADING !s brd OnIY! QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE 132-371 116531 (5151 38.5 H653 15L51 EX of TYPE AVERAGE MAXIMUM U MINIMUM AVERAGE MAXIMUM UNITS rei.es) MALY515 (515e1 159-701 JLL I,,,r IL,T:.L SAMPLE !~i~A0rr4 1'r4#r#•! #4###f 1 ) •: 1 ~ ~..L Y L J MEASUREMENT ' ~ (v. o ~ 1 i) li PERMIT #r 7r iRbk " ~ ....." .;~1##:., ~` ~ . . ## ,~ i. 'ji:f':~:'~.~..,.~,::. ~. }r1.~"f~ [l.l~ l'~ i:r t 1. u6v Ni:.. F!c~. ~(~. . ,,:.l L" . ~Yr L.rcai l,n:;~/ :l ALU REQUIREMENT ~ .., ~ ... $~. ~• . ~t~q:*~:•:~a~~.:~~..~ ~~`~, ~~~~~ ~~.: f~ ~s< !AX SAMPLE t MEASUREMENT a`r ..': ~ PERMIT ~. ~ .... .. ..:.,.: ~ ~ -~~ ~ ... :, ~~ :REQUTAENIENT ~ ~ ~~ ` SAMPLE MEASUREMENT ., PERMIT .. ... ~ ~ "~:'..::~:: . . • :..~. ". ~ ~ ~ ~ ~ ... :.::::;;g::?,:::~„~?:: ....~;:. ~ ~ ~ ~ ~ " REQUIREMENT ~ . .. .:. , ; :: .. .. ... .: . SAMPLE MEASUREMENT : " ~ PERMLT."~ ~ . ~ .. ...:. ~ ~ . ....::. .. ~ ..: r:<.~ ~::. .:: ::.: ...,::.. ...: ~ ~~... .. . .. REQUIREMENT ~ ~ ~~ SAMPLE MEASUREMENT ..:.. PERMIT:":: ~ ~ ~ ~~ ~~ ~ ~ ~ . ~ ~ ~ ~~ ~ ~~ ~ ~ :.:.:::'~' :'.:~': REQUIREMENT' ~ ~ ~ ~ r , ~ ~ "" SAMPLE MEASUREMENT PERMIT " ~. : : ~ ~ ~ ~ ~:.. :. .:. ... .: ~ .. ,. "REQUIREMENT ~ ~ ~ ~ ~ "" SAMPLE MEASUREMENT ~~ PERMIT NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTI AM fA FY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY E%AMINED MD MILIM WITH THE INFORMATION SUBMITTED HEREIN; MO BASED ON TELEPHONE . DATE 1' I(:fl I-l~ ~:TIII$ MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY PESPONSIBLE FOfl OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS j ~ ~~ ~ ~ _ S ^'f r'1- ~-'1 VII'~In ra L^ ntlT ' TRUE. ACCURATE AND COMPLETE. I AM AWME THAT THERE ME SIONIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING ~ i' / ~ \ I9]1~ 8]0-Z7~2 T~ / ~'7 9R l ., C . - , THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 1B U.S.C. 1 1001 MD 33 , F E UTNE + , U.S.C. 1 1]Ie. IhNle4. uwr N.r mwrn. Try McAMr 5rws tP ro 110,000 gIONATUAE O PRINGPAL EX C AR A ~ TYPED OR PRINTED .nd ormv4nyrl Mpionrrn or Mfwwn a monNa ATM 5 Frra/ OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/wence a!l errschments hare) _~I i~L ti~LC ~~t i"`, L1M[T naI4 Lit FUK lOYnr~4n-. P.Li-I~~ ,!I_:7-~l.c i.a. s, F.. iw. r~-. -:_~v.r i^,L 1,1 LLB c. ... ~w ~L onAC ~i.MFLL AnALY~1S ht'vUlhtU lh Y1SI:aLL ~YItL .~ 1~ v: ~..KJc 'u. v`°TkLY ~,; hr Li:•.. I:I~Iri Ul,l1::1+:',-T ..-..,r L EPAForm 3320-1 108-961 Previous editions mey be uaed. (REPLACER EPA FORM T30 WHICH MAY NOT BE URED.1 PAGE OF ~JJllt/itl~vl-1311