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PERMITTEE NAME/ADDRESS (/rL4 FrIRy Nsr/laanm dD~i,.nr) <br />NAME L;YFItu `.: %ilh'1F;% ~v.~r V:•aT lL.ii+ <br />ADDRESS 1~ V y;JA 6~ <br />_ GKp1Lt t•U e1bLJ <br />FACILITY i.YPhUS Lf7Nln'r_ CUF'.FUnaTflJt\ <br />LOCATION 1. M1 A l ~ C Li t,1 16 2 rJ <br />.+i]?. "Il~nai_L .,. ~uL'u.: „1-.J}KAI r.l:a <br />NATONAL POLLUTMT DISCHMOE EUMINATIOM SYSTEM /NPOES/ <br />DISCHARGE MONITORING REPOflT lO Rl <br />1-161 I7-191 <br />PERMIT NUMBER DISCHMGE NUMBER <br />v ~ -MONITORING' PERIOD <br />YEAR ~ 0 OAY YEAR MO DAV~ <br />FROM. 0 j ro i,y - y 30 <br />l2 2.tf 1 31 116251 126-271 128-291 /30-3/1 <br />...~.: v Jives >1.: i:: <br />J L•i, ll I\/1 <br />F - r1NAL <br />Form Approved. <br />~r~a I l~of ~r>,ao-ogoa <br />ppiove expirpe 05-31=98 <br />1 2 j'1 J <br />Ml~:ul< <br />*** NU OISCHARC~E *** <br />NOTE: Reed Inetrvedone e}or com IetlnO thb form. <br />PARAMETER !3 A/d Onlyl QUANTRY OR LOA II Grd Ontyl QUANTITY OR CONCENTRATION NO. FgEDUENCr SAMPLE <br /> 146-53 /5661 1.38-16 (46-53 66B/ DF <br />131-371 EX <br />MALrsI3 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-ell (66681 169-701 <br />OlL1uSE T,;TAL SAMPLE ;{. .y :.,;.:~. .;,};.,}*;. wMP**#' 19 <br />u 1 S iuL Y c ~ MEASUREMENT <br />T l:~y~ 1 (; U PERMIT ~,ta>;S i41# ~~<~+-P~* %~b* +~.>k~~~F:. ~.: <br />,. <br />~:':~~~~ ~i c'E~1J7~~: ~~ <br />~~fjNAL:. <br />: <br />~ <br />~:. <br />~~' <br />'~ <br />: <br />~`~~~ <br /> <br />~rra_t,tivT uK SS YA Uc REQUIREMENT <br />~.*v>tl:. .. <br /> <br /> <br /> <br />.. <br />?;,:":. <br />,. .. <br />..: <br />: <br />.., ... <br /> <br /> <br />4 <br /> <br />...::.. <br />. <br />" <br />: <br />,..,. <br /> <br /> <br />. <br />~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~? PERMIT. ~, ~ ~ '~ "~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT . .: .. .: .:.. ~ :. <br /> ijEQUIHEMENT~ <br /> SAMPLE <br /> MEASUREMENT <br /> '~ ~ PERMIT : :, .. .. <br />" <br />: .;. <br />: <br /> <br />'REQUIREMENT <br />~ ~ . <br /> <br />~~~ <br />~ ~~ r .. <br />. <br /> SAMPLE <br /> MEASUREMENT <br />' <br /> .~::~~PERM17..'~. ~:. ~ <br /> <br />~ ~ ..... <br /> <br />~~ <br /> <br />~ <br /> <br />~~~`"~ <br />~ ~ <br />::: <br />. ' <br />:red ::.::..:. <br />:: <br />.. <br /> REQUIfIEMENT~ ~' <br />~ '~" ' <br />' ~ ' . <br />. ' <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT~~~.. ~.. <br />.. ... <br />...... <br /> REQUIREMENY. <br /> SAMPLE <br /> MEASUREMENT <br /> ~'~ PERMIT'..:. .: .:~ . ..:.... .. .. .... <br /> <br /> <br />NAMErtITLE PRINCIPAL EXECUTIVE OFFICER I cegn <br />AM FA Fr ugosR PENALTr of LAw TNAT I NAVE PERSONALLY ExAMINFD MD <br />MILIM WITH TNF IN <br />ppppMATION <br />UBMITTED HEREIN <br />MD BASED TELEPHONE DATE <br /> p <br />; <br />ON <br />S <br />Mr INQUIRY OF THO6E IND <br />NDUALS IMMEDIATELY RESPON51eLE FOP <br />ItICT1.'.Y(I F:III~S I <br />OBTNNING THE INFORMATION, J eEUEVE THE SUBMITTED INFORMATION IS ~ ~ ~J <br /> <br />Lnvil-onmer <br />1 <br />4ana <br />t <br />:l <br />:er TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIOHIFCMT PENILLTIES FOR SUeMITTINO FALSE INFORMATION <br />INCLUDING (((~~~ <br />7 <br />~ 9] <br />~7tl-~~~ ~ <br />~ <br />Q <br />~ <br />Q <br />, <br />, <br />. <br />. <br />c , <br />THE POSSISIUTY OF FINE MD <br />1 <br />PR <br />SON <br />E <br />T <br />SEE ~ . <br /> IM <br />I <br />M <br />N <br />. <br />1S U.S.C. 1 <br />001 MD S! BIONATUIIE Of PRINCM <br />L EXE <br />UT <br />E <br /> ~. rw ~+ mnrl~.F m.r hrArw ~xw. W ro t /0,000 <br />rM w <br />uMU A <br />C <br />IV <br />TYPED OR PRINTED m <br />n <br />M+dMl.rrr e/atwwremenw reds /oral OFFICER OR AUTNORI2ED AOEM CODE NUMBER YEAR MO DAY <br />.,vmmo. I ~ nnv cnrr-nnn r rvn yr nn r vw~n r rvna merrience en err~cnmenrs nerel <br />.,cfiLcAni_c ~LL1L:~ Llnl! ryp1JEU FLK 1vYkF~4r1K FKtCIr ~Vc:NT-';~_ i.A.3, F't, !y. FUK KCWUIkGM~nT~. uIL_ ~ <br />~r:~a~t ~rtNO ~pl"T'Lt ANALYSIS KEi,U1KE0 if VIS1tlLE ~Ytcth !:i L.;~c~<'ILli. ,IkI~LT Cpl"FLING jNSIKUCTIGIvS-1.~.:.s <br />~J l~_ Y <br />EPA Form 3320-1 IOB-961 Prsvlow adRlons mey bs used. (REPLACES EPA FORM T<0 WHICH MAY NOT BE USED.1 tl U L U 5 / 901 U u 1- 1 3 1 1 PAGE !OF <br />