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PERMITTEE NAME/ADDRESS p,.eV4 FacYrry N..r!<ranen lJOl))Grwn)
<br />NAME . _ ./ _ .1 S .• A w n n '+ - _ .. _ ~
<br />ADDRESS 'LN l.-i 1 Zia c/)~ r• .•
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<br />LOCATION
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<br />NATIONAL POLLIIrMT DISCNMOE ELIMINATION SYSTEM INPOESI Form Approved.
<br />DISCHARGE MONITORING REPORT lOMRI OMB No. 2040-0004
<br />`) /~ U 2 71 i u (\ ~ r e / _ ~ „ u, f l ApproGe, e~pires.0531.98
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<br />PERMIT NUMBER DISCHMGENUMBER r _ /
<br />MONITORING PERIOD .~
<br />YEAR MO DAY YEAR MO DAV
<br />FROM '+ 7 TO ,-., qr - ~;:-: -~ •~T ~~(,-11 r^,c I t`-': t:
<br />116111 111-131 114151 116-77I 118-191 !3631/ -NOTE: Raad inetructiom 6afors fompletinp this Corm.
<br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION ~I,{D FREDUENCY SAMPLE
<br /> 106-531 154-611 I3BJ51 1a6-531 !5461 DF
<br />I31-37I EX
<br />MALYSIS 7yPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sD-e]1 !54681 159-701
<br />:+.i SAMPLE "-:~ 344:: -~:#rr::7: ( 1 ~)
<br /> MEASUREMENT
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<br />1 P ; -: ;1 ^ ~; MEASUREMENT
<br />J`13~ T. f! 1 .:AERMIT ~ 3DS C.a#6 ~
<br />~ 4RpG491 ~ #;~ R#~r#,l;r 15 ~ 7D ~ NStf £/ CRAB
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<br />C {';!: SAMPLE .:R:: .fir. C#3r .# :y #:pr~T: ( r ~)
<br />t 7 C,9 I. F F: ;; 7 F `.' is A? L ~ MEASUREMENT
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<br />,.. ,. •,9i :'075 `. VAi CF
<br />, REQUIREMENT
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<br />.L;, .L PI. v3..AiF SAMPLE ,-. `. ': ;:{: '+####:`• t#..t'.`-•: a. :,t^... ( 11)
<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />MILIM WITH THE INFORMATION SUBMITTED H NALLY E%AMINED MD
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<br />AND BASED ON
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<br />MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS .-
<br />. TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
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<br />i SIGNIRCMT PENALTIES FOR SVBMITTING FALSE INFORMATION
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<br />!MI6 SIGNATURE OF PIIINCIPAL EXECUTIVE
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<br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) ~ ,I ~ r T r ~ ~ n,l „ T _ i O { ~ PAGE OF
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