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PERMITfEE NAMEIADDRESSD~drFSihryNaWlncalm r/Dr>)frnnq <br />NAME (,YrnL.~ cr,rLr.! l,L)Ki'uKAT1~N <br />ADDRESS ri U ::4A Gtf <br />•Ltt/11G l,U t,l UGir <br />FACaITY (,YNnI,S. tH;'lkt GOKi't,xAT IUM <br />LGCnnoNC4A1G 4Q uiDLi <br />ATTty NILnAtL n. L'J iiL L'kl. bL(irh.a ii w: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVBTEM (NPDESI <br />DISCHARGE MONRORING REPORT IDMRI <br />(1-161 II7-19) <br />~PERMfT NUMBER a cY 9ER <br />MONITORING PERIOD <br />YEA `HMO DAY. YEAR MO DAY <br />FROM ~) GI TO ~ 93 U') :~v <br />124711 1 !26251 ~. ~1I61T1 126-19/ !34311 <br />.~~.~~ iv oir rln <br />SUf3K i'.n <br />r - FI:i.:L <br />ht1hU' <br />Form Approved. <br />I L OI~yB; [~o., 2040-0OC4 <br />Appiove expvee 65-37-98 <br />1_~-I) <br />n <br />~r., v r i1-f1Art ~.C 1'~'iti <br />~~ NOTE: Reed inetructime bel a co pletinQ this form. <br />PARAMETER l3 GN OntyI QUANTITY OR LOADIN <br />" I{!iid,Onlyl QUANTITY OR CONCENTRATION / ND. FREQUENCY SAMPLE <br /> !4653/ (56611 ,:5.' 9BJ61 !4653 (566/1 EX OF <br />132.37/ . <br />ANALYgs TYPE <br /> AVERAGE MAXIMUM UNIT '.`~ ~' `IMUM'~ AVERAGE MAXIMUM UNITS 1e2691 !6658/ 169-701 <br />~L,LIU~F IvTAL SAMPLE 4$#yAa?# •}tf~~•#r 4+RIFiI#Ih 1': <br />.11~~i,LVL~ MEASUREMENT <br /> <br />/~L Y7 1 G 0 <br />~~.PF,R.MIT..:;::. <br />~:r~.A ~f >f ~VI~R~ ~:rel~a~a~x <:,<,r <br />' +[v~kl~#I; <br /> <br />r <br />• :...+Z.~FyDRT: UPTlt.lriAL TLi ,ii Ac <br /> REQUIREMENT • <br />~ ..., <br />..•. . <br /> SAMPLE <br /> MEASUREMENT <br /> Y, f <br /> <br /> . SAMPLE ` <br /> MEASUREMENT <br /> <br /> <br />- ~ <br />::PEdUIREMEN!Il; <br /> <br />.. <br />~ ~ ,. <br />:..r. ~•+: ~ ~ '.. ~:..".':: <br />:,a:.:.:::~~':~~.:~~~:. ~: <br /> SAMPLE <br />.. MEASUREMENT ' <br /> <br /> EQ.U~REMENT . <br /> • . SAMPLE <br /> MEASUREMENT <br /> .:. <br />EAM ,.. <br />P ; <br />.. <br /> ~ <br /> SA'MPLE <br /> MEASUREMENT <br />' <br /> .. ,. <br /> w~avip~iN~Eplt <br />~~ . .. <br /> ~: SAMPLE. <br />' MEASUREMENT <br /> -.. ... <br /> <br />NAME/TITLE PRINCIR L'~XECUTNE OFFICER ~ CERTIFY UNDER PENALT OF <br />AM FAMILIMI WITH <br />TNE INFO LAW,TNAT I NAPE PER80NµLY ExAMI <br />AND BA <br />RpMNAT <br />ON SUEMITTED HEREIN NED AND <br />SED ON TELEPHONE DATE <br />' `` <br />; <br />. <br />RE <br />ON4 <br />T <br />ICI <br />S <br />M <br />TE <br />' LE F <br />R r <br /> <br />Richard ILiI IIS MY INOUIRyy OF <br />IM <br />EDIA <br />LY <br />SP <br />B <br />HOBE <br />INC <br />IDUAL <br />OBTAINING 1HE INFORMATON;'1 BEUE4E THE Bl1BMITTED INfORMA O <br />TION IB / <br />/ ~ <br />,~ <br /> <br />M <br />r TgUF, ACCUMTF AND COMPLL7F J AM AWARE THAT THE <br />BMITTNG FALBE INFORMATION <br />IN <br />s <br />O <br />HCANT PENALT1f <br />5 FOR RE ME <br />CLUDING / <br />`]7O~II70~27~2 <br />T~ <br />~ <br />~~' <br />anage <br />Tinvironrlerrtat , <br />, <br />I <br />NI <br />]L t <br /> THE POSSIBILITY OF ANE AND IMRLSONMENT. SEE 18 U.B.C.) 1001 AND ]] F <br /> <br />U.S.C. S 1 ]le. (FrWtl.r uM~r VwAr AberNa nvY 4cX.dF lxwa W ro J 10,000 SIGNATURE O <br />P111NdPAL EXECUTIVE <br />TYPED OR PRINTED wrcmvimun inpismwnr WerrwMnemgltlra rltl6 S.e-al OFFlCER OR AUTHOR12ED AGENT CODE .NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rsferencs e!/ eltechments here) <br />jLllLta,il~ SIJLIU~ L1M1T ;~ti1VED Ft]R 1GYr~,24H~ P,~tCIr t'vtwT-~tc I.A.1/ ?b IvF Fv:: r~.t(ruikEMEkTS. i,iL .. <br />L,n~ASt LIriAB SAMVLE ANALYSIS Rt61U1K~EJ 1F ViS1vLl SHEEN iS iJ~StRY[D. •.ikT.<LY ~A%'Ir'LINt: lNS7RUl:7I;,fv:i-i.C.,.;t <br />EP Form 3320-1 108.951 Previous editions mey be used. (REPLACES EPA FORM TJiO WHICH MAY NOT BE USED.) u U.13 7 / yo I C J I~ 131 1 PAGE I OF <br />