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PERMIITEE NAME/ADDRESS /hrLd. frWryNa/L«anen dOr]Tv.nr) <br />ADDRESS ,1 11. ~. ~ , s i , r, .. ~ . ~ ^, <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTMT OISCHMOE ELIMINATION S1'STFM /NPOE$l <br />DISCHARGE MONITORING REPORT lOMRI <br />!Z- I61 17- I9I <br />:'70727i5U ^ 4 7 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM + > 1 TO 'a'1 `. <br />!1611/ I21-231 /14(51 116-I7I 118-191 !36311 <br />Form Approved. <br />., T ,i ~ T , r _ _ .- ~ rOMB1No: 20,40.-0004- <br />(..,, .~ ., r.: ~ Approved expir~ee OS-31-98 <br />.- _ r' ] i. <br />r- - <br />yyt <br />.. NOTE: Reed Inetructloro belorl c'omplBGnq this }orm. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !1 Grd Onlyl QUANTITY OR CONCENTRATION NQ fREOUENCY SAMPLE <br /> 146-531 !546/1 !38<51 146-531 1546/1 GF <br />IJI-37) EX <br />MALVSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163.691 I64-681 169-701 <br />7:'~Ak£S-'F T~1'••. SAMPLE ~.. .r, F#R?;<'A . . ,.. <br />i3 1 <br />p <br />p <br />2S~j ( 19~ <br />O <br />~~3 <br />gLCY~ <br />"C )YBHA.'.Lr MEASUREMENT l r ) <br />l/ ~ <br />:11_.i 1 :' 1 PERMIT ~~G:::=~k :} ;S C+i'.x:t Jt r,• Yc~ ?#t_;frtR j.il Sv F"pr ~ ,. <br />2•^v'/ ".h L'"r'7 <br />~'cc1..U'um ~o');3 YAL9F REQUIREMENT #1=`R 17,^.a aVn nlrLY wg w^ ?.' ,i <br />''i.iltF iti ~"7 VIl'li* OR SAMPLE 11 <br />~~ .7 <br />2 <br />oq~ ~ ~.j) >r'Sf.'!.<^- .-::'•k ::>rA ,,.-,,. TT 1 <br />CY <br />"x.37 T.t~d3,'Y~~1^' ?LAN MEASUREMENT II <br />..J . V ~ CAL <br />7!1 '1~'l 1 U i PERMIT $E$~Y'1/ RI:D(1RT Rx4>Y#:::r ;<#t;:-..-" .Z¢;r,~±n 1 ~-kk NCF'/ :>xLCT:' <br />,ffLJEVT ;P7^,^ VALO fiEQUIREMEN7 30DA 1-Y~ i)~iLY 11!Y 1107 +z':r~: '~nI;T•i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY EXAMINED MD <br />MILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BARED ON TELEPHONE DATE <br /> <br />Richard Nlills MY INOUIIfY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />~ <br /> <br />[iIVIYDnIR?i!iE:l ~•la lice gar TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />~ '~ <br />(97C)H%~-2712 <br />I) <br />2S <br />9H <br />~' . <br />THE POSSIBILITY OF FINE MD IMPNSONMENT. BEE to U.S.C. 1 1001 MD ]] <br />BIONATURE OF PRINCIPAL EXECUTR/E <br /> U.S.C. 1 1]te. lAxWr4. ulcer bur mnm. nuF Ixhd~ ruwa rq ro t10.OD0 AREA <br />TYPED OR PRINTED rMw muirvn vrlpisalnwNarMlwrnsmondu.nds yrrsl OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAV <br />GUMMCrV 1 J ANU [Ar'LANA I ION VF AIYT VIOLA I IVIVp IrEerererlCB 9// erreCRTBnr9 natal <br />I _-.'iP1IFh: j_'-DnY R,•rd•.... °~v^.-.',7n7PL7": ~I~C;r'; A ~1C'~ ,[. 4~fpa:+^~r!' ycer, 1r -r/ ':^F~. .ol•Tm -^ <br />-., .?L55 a/LL4'~ '.7 A'P ^~It', ". 'i71At O1S7 c'I? '1:77 ir0'C.r- ^r- nc.,r..;.7y: Pra,r.i(,_T.°.T °•, ^1 ':. <br />_t <br />EPA Form 3320-1 108.961 Pravioue editions may bs used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 n ., .. ~ ,: / ^ a r ~ r 7 _ n PAGE ~ OF <br />T i. 3 , <br />_ ~ r' .. <br />