|
PERMITTEE NAME/ADDREBSpMi4 FrdlyNr•/orwm UD~.mc)
<br />NAME C f P !? U S `/ f= t~ B v(+ T•. v " ..,. e 1 ' D^ P.
<br />ADDRESS `• I N ° ~., ~ , ~ ~ ~ r n
<br />`3109 F,-w I`,~..,~ ..r.._~ _.
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCNMOE EUMINATON SYSTEM lNPDESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />n-1s~ rn-1s
<br />^7!1D 711:1 ^~^
<br />PERMIT NUMBER DISCHMGE NUMBFA
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM .1. TO ''' •~
<br />l10z11 !z3-z31 114151 l16-271 l18-181 l3a3//
<br />- --- - -Form Approved. __
<br />°InA ^ISCHAR ;P. TOD~e)N°n Za4O"OOO4
<br />ra .. o r uV) APProvel exP,iras 037-98
<br />S ~
<br />- _ v r r ~ l
<br />.. ~~ ~
<br />..1
<br />NOTE: Read Inetructione before cerllplatln0 thb form.
<br />PARAMETER l3 Gre OnlFl QUANTITY OR LOADING f1 Cerd OnlYl QUANTITY OR CONCENTRATION ND FREOUFNCY SAMPLE
<br /> lab-531 !5<-611 138J51 lab-531 !54871 EX of
<br />TYPE
<br />l3Z-371 MALrss
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs:-sal !54681 169-701
<br />~.; SAMPLE . , Y:~r:~ . , . -. ':.,.; ...::. I T ~)
<br /> MEASUREMENT
<br />'r ~. 1l~D 7 f ~ PERMIT R« ". ;=;= '=.iA>"-'~: .. li.y .-,: z:fix~. :1.~ P~.~.vT,'" ~"~4
<br />;'FFLU-: .1 _' -1-"5 V.4I,Uc REQUIREMENT ~ .;eR 'IChT`til'=~ '~'i'!T'"r'M "''
<br />~JLID:iF i,l'"+. T. SAMPLE +`-~St:t`-.? «r..::CrG# t.r-;~:•:r: ~ )D)
<br />u ~~ P E ~' D -: L' MEASUREMENT
<br />77'T~0 ^. D PERMIT «OO?xO ««OrXf'>h L OO` ?f«a"s+7aieyt. 35 7n R?t"P/ :SAP
<br />•F~"LUG ";r75S VA1,I" ,REQUIREMENT ?L`NO 3f7nA .Aqr 11ATIY "1X pr/L KON'.'H
<br />' ?:J ~! SAMPLE ^.n a«Ort ~:}:„•:~ #*}r',: ~~;- ~ t ~)
<br />")"+L :°~:?V'-~.~'f.' MEASUREMENT
<br />_ :3 }'~ 1 ~ ~~ PERMIT ^.c:; .:r:-;t .C:Xr Y.i:
<br />. ._.,,.L.~;~. 1.t' •t~ Ft)`T 'iRPE/ ~ qil a
<br />_rvr,U .. fII ':hJS' ''^. ', rT- REQUIREMENT r, :::~~: 7!)„17 p^, IiOTL? "k' ~"/T u'77TN
<br />_ ..'/"~!• °7TF'H ;~.~ l.' SAMPLE ;: •a ,.._.y ;: ^;h~.^.«.y f..,.r,.._,.: ( ) )~
<br />-': COL•/-~_: MEASUREMENT
<br />1i7L4 1 D ;1 PERMIT ',=t~F/fF~ {t#PL<,:=t w r-a;: ,':'1C[-, r,t-n'1' n n•7 ,T "fgTC/ ;~19
<br />...'1 `: ':^ JRJiS ~/AT'I~
<br />• REQUIREMENT ~
<br />_ #.'.:t: ~k 1D1<0. 9!?^ S73T Iv yx c.:./L y^tP'nu
<br />
<br />,.
<br />_
<br />-~~: h. 1IF ?OltilTT aL LY SAMPLE .`<<rA ta.:::7'._{: -k .-'.+{:.+,: ~ =~)
<br />,I.;~uj,y ~; ,, MEASUREMENT
<br />11!J'; 1 0 0 PERMIT Ors S¢4r r=C ~Qis;T . r,:::~ rtrv'<-? (1,D7'1 ^.]Tn y:~:/ ~aAA
<br />;FFLiI i•: ~+IT GROSS VALU REQUIREMENT ~ ~DhA. R, ,7^ D0.TI! M`." ^~T/L NC1;Tlr
<br />1.. .. n D .iRF.0.iF SAMPLE ^w:C ^.:4v q^ ,..fit. ..: .ti ...Z, ~ I4)
<br /> MEASUREMENT
<br />13~!Il 1 D ~ PERMIT °: Y,::r :-; .= :`G~X«0+01 t O><: r ... ..... .;h T 0~ .l .7 ;;TT + •74R
<br />.f ?LUF:RT GR^,'i~ ':ALiIP REQUIREMENT ~ '.•-~'.t X!IST NA7I rr/L ~.i''AT
<br />,N.+A. S..A 7. SAMPLE Yr EXP.^^-~.~y ,.;.f;.,~., i ~~~)
<br />~':7 Y t. P A 9 L g MEASUREMENT
<br />Li1~3 1 J ~ PERMIT :°X'w `++~ t!^-s:== ^ :~",. -.., Ccr•t1Fm 7r fir; e, ~)• - Irp7 ;'..A~
<br />°~LUENT .irDi' '?iL'I° REQUIREMENT "*kT-"• ~11I171 aq.^. t1}Ilv vT v /r +~nl;.ll
<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> I
<br />I
<br />Y
<br />NS
<br />E
<br />E
<br />E --
<br />Nicharci P,4ills R
<br />MY INDUIRY OF THOSE INDIV
<br />DUALS IMMED
<br />AT
<br />L
<br />SPO
<br />IBL
<br />FOR
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS n
<br />/
<br />~~
<br />
<br />
<br />Environmental ''snager
<br />TRUE. ACCUMTE MD COMPLETE. 1 AM AWMF THAT THERE ME
<br />SIONIFCMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ` / ~
<br />/ /
<br />/
<br />LGC"
<br /> ,
<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD ]] _ _
<br />
<br />BIONATURE OF PRINCIPAL EXECUTIVE
<br />i7D
<br />£7D-L71 Z
<br />Z
<br />Z 5
<br />`.~,~
<br />
<br />TYPED OR PRINTED U.S.C. ] 1 ]le. lMrlb• unex eNr mnm• AI.Y hcl~.ae ring w b 310,000
<br />uM Ormuimm Nlplrovnrlr er Mfru.r encneo rK6FerA1
<br />OFFICER OR AUTHORIZED AOENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />
<br />E~
<br />I
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/rrence sl/ eftschmsnfs here!
<br />..r
<br />IL ti G4LA vG' - ~~... Fir` :-)°, .. '/I ?• ~• '_I'il ~f1 i-1.^I1.. iT`+T,^C - ~qr r1i, .^•^; T./• vr, .. nr.r. 1. .1~-'"L'.
<br />~ '.~ - F7'JT..,T.. './. "0± '•~NT1'.','I`I.. ... ^JM~c. I'. ;"TT-,., ~a r'' ^q~TnaSrvr T
<br />c - _
<br />EPA Fam 3320-T 108-951 Previous editions mey be used. (REPLACES EPA FORM Td0 WHICH MAV NOT BE USED.1 ~ ~ ~ ^ ~ / ~ _ ~ ., ,1.T - 1 ~ T ,~ PAOE - OF
<br />
<br />
|