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<br />PERMITTEE NAME/ADDRE56 l1Mnb Fm•YrryNw/LUarron rJDrfArwrp <br />NAME L,YPn::: :: ;:7Nlr. r_ i.•-;~F~u~: ALT lun <br />ADDRESS }7r u dUX (1C <br />~' L.ttA1v ~U f51b.'_o <br />NATIONAL POLLUTMT DISCHMOE ELIMINATON SYS i EM INPDESf <br />DISCHARGE MONITORING REPCR? lOMRI <br />/1-161 !; 7-191 <br />r, <br />PERMIT NUMBER DIS:HMGE NUMBER <br />MONITORING PERIOD <br />YFAR MO DqY I~ YEAR MO DAY <br />FROM -- 4 , ?f0 d IJ 3G <br />l2Q;211 (22.231 !16 i? !24271 I28-291 !30.3!1 <br />. ~. .-- ~L Li'.-y1.1 <br />~~,Gri lyN <br />F - F I;~AL <br />Form Approved. <br />T ~, OM~ L'9. ionap ~oooa <br />App ove e~pirss 05-37-98 <br />~~~~. <br />FACILITY (.Yt'rCUS tMF'1Kt 1:~.:nr'L1;iAl1LiN <br />LocnnoN ~ K A 1 ~ l:%+ I; l u /.5 <br />A 1 fh MILr1AEL~ w. LUULi,n. ~.trvcktiL Milt <br />filNuF: <br />NOTE: Reed knvuctierw bsfor~ c Htinp thu }wm. <br />PARAMETER B Grd Onlyl OUANTI7Y OR~LOADING - ;Ord only! QUANTRY OR CONCENTRATION / NO FREQUENCY SAMPLE <br />. 146-53I /51-611 !38-051 !46531 !54611 <br />EX DF <br />132-371 gVERfAGE MAXIMUM UN MINIMUM AVERAGE MAXIMUM UNITS <br />162-6J/ MALVas <br />/6/-651 TYPE <br />/69-701 <br />_i~ A:v~ urttASE = SAMPLE *##f#p ~ y4 i+?i0~k# >;.,r,~;:tr;. {.:.:..y,;.;< <br />Y 1 ;, S A L MEASVREMENT . <br />•.;4,;~b 1 C/ U .....?5R.M13:..`''?:r~ ~~.:.;~k*it'. <br />~~~~~~: <br />~ ::,..:.....~.:`~'~~t~~..~ 5 i #~!kt9 <br />A3!akk:... •><#.~k4~i ~R+Fr?~r#>&. , :.:.:, i~i~:~/ i:.t,i.i. <br /> <br />LrFLUctil uKUS VALU ~,REQUIEiEME.. F: <br />.:.....:...:. h<:: .: <br />..: <br />~. ~....:..... .: ~. ~ <br />. ..r. '. ~ .. .'...:::. . <br />... .. y <br />~'~ M11~ <br /> <br />in ~ . <br />,; :..:a ;;j„. . <br />.: :. .::". ... <br />.... <br /> <br />~Y St is ~i <br /> <br />:~:~~1 'r <br /> SAMPLE <br /> MEASUREMENT <br /> ~~.~ PERMIT .. ... <br /> .REOUIREMENT> ~ .. ~ .... .... .. .... <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~R.ECFUIREMEMT: <br />- ... .. :. <br />.. .. ~ ~~ <br /> <br />. ~ <br /> <br />.. u. .:..:.. ~~ <br /> <br />.. :• <br /> SAMPLE <br /> MEASUREMENT <br /> ~ ~ <br />' <br /> RECIULREMENT~ : ~ ~ . ~ ... .. .. ., . ~ <br />,. :.... .., <br />-c: <br />..~~. .. ~ ~. <br /> SAMPLE <br /> MEASUREMENT <br /> <br />... PERMIT::: ~'~ <br />~ ~ ~ <br />.. ~ ~ ..: <br />~ ~ ~ ~~~ <br />:<"::.:::: .. <br /> <br /> SAMPLE <br />' MEASUREMENT <br /> .,..P.9M?7.._?. : <br />-.. <br /> `Rl;CiuIREMENt~.. ~ ~~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PE Ad1T'- ;~ :.:, ,... <br /> . . <br />....... <br /> <br />NAME/TITLE PRINCIPAL.EXECUTNE~~OFFICER I CEflTIFY UNDER PENALTY QF l <br />AM FAMILIM WITH THE IN O :~W THAT I ryAVE PERSONALLY E1fAMINED MD <br />MD BASED ON <br />R ION SUBMITTED HEREIN TELEPHCINE DATE <br />- ; <br />MY INQUIRY OF THOSE IHr>tv1 UALS IMMEDIATEEY RESPONABLE FOR ^ q <br />1 <br />, <br /> <br />hichard 14IIIiS OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS <br />I / <br />- ~ ' <br /> THERE ME <br />T6UE, ACCURATE AND COMRETE. r AM AWME THA <br />QNIFICMT PENALTIES FOR SUBMITTING FALSE IHFORMATION <br />INCLUDING <br />S <br />~~ O <br />R <br />Fnvlrnr.mental r.tanagP}' , <br />I <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. f 1001 AND 3J - <br />~ SI <br />ATlN1E OF PAIN <br />WAL EXECUTIVE {q]Q Qr]Q-~ZTI2 AST ~ <br />TYPED OR PRINTED .ns~o: rnuJiwn ~ ' n~wa~~..n~~r,w~lemr, ~ ~y..•.~,lA'O ro r lo,ooD ON <br />C <br />DFF7CER OR Al/TMON2ED AGENT A 'q <br />CODE NUMCFR ~ YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lReterence a//sttscnmsnts hrrel <br />~:.f lLc AdLc SUL1~S LlP11T N4I VtU FUK' lUYKF24tfk !'~2t:. iN ,-Yc:1T-SEk 1.A. i~ Pi, Lve I~.~ K~4UI REMichTS. L:IL ;. <br />~RLr:DC ~~ad 5a'1rLc arvaLYS-S ktdULkEU 1F YLSlL9LE SH~tfr I; udStRYEO. QkTKLY ;:,rtF~i:.(, INSTRUCTIUIV:i-I.~.at <br />EP Foam 3320-1 108.951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ~ ~ 3 ~ ~ / `) c: l U J 1- 13 L i PAGE 1 OF <br />