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PERMITTEE NAME/ADDRESS pn.i,4. Farmry Naw/lasum dDlp....q <br />NAME C Y ~ . r . ~ ., 1 - ~ ~ L ' ~ <br />ADDRESS `. i Y .... ~ F i i _ - A ~ K M A <br />`110) ..`4~T 'T' ~T.i~Li? <br />FACILITY <br />LOCATION <br />:.T".. 90NP,IS M• "_, .YF ''NE['I iY <br />xATIONAL POLLUTANT DISCHMGE ELIMINATON SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT lOMRI <br />T-161 I77-191 <br />'J00171~'1 ^'" <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM ' _ TO ` ' I. <br />!TO-Tfl !TT-T31 IT4T51 /1G171 !TB-T91 !36311 <br />' Form Approved. <br />M*`~° `1T'CN? ~'' T10fy18~Noq 2040-0004 <br />r .., ... ,. , . Approve, exPlreo OS-31-98 <br />^ • f' A i, <br />M! l1 <br />NOTE: Reed Inatructiom befor eomplatlnp this form. <br />PARAMETER !J Grd Onryl GUANTITY OR LOADING !4 Grd Onlyl GUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> l/6-531 !54611 l3B-451 !46531 !5461 OF <br />l3T-371 ~ EX MALY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsT-sJ/ !µ6g) 169-701 <br />'L )K, IN :D1:7"I° r1D SAMPLE ( 93) #:. ..... ... .. ': r-r:,+ <br />,. ill r. R R a r r i• `~ T -' L A V'. MEASUREMENT <br />S I`:ISf) 1 ^ '1 PERMIT RRP~ar Rr, k#~:,.ww r:... w:Y~Y; ~~. #~..~F , .,: .: .: '`Ig'"AH <br />'F=LUF'F'° ;I"}~S YAT.IIr REQUIREMENT SODA xYG 7AILY'!?C "!6:, <br />A <br />.i i~:•TD$E iJTaL SAMPLE +.•~. `•'k .:?0::'Y t:3#3~^.^ ( <br />T 7) <br />' : `.+=DLL ' J MEASUREMENT <br />11)r:'IS 1 ~) ;l PERMIT O#Sc .~#~ :k#a"~r A. ~ s4k 'k #>.+### REPf7 F^.' R~ <br />POP.T Il! <br />HR.. ! <br />:RA!! <br />:Fi'1.llE';. '„,"~~S Y4 f.l!'• REQUIREMENT a^kR 34DA AVC DATIT ?!$ r!;/L 270N R <br />'IL AV.' ",rF.4 C.. SAMPLE . ~7:ytY; ( 1U~ . . :t## ...k'; :t,. x#...:#r: <br />I : J'J A L MEASUREMENT <br />u -:, F, 1 O PERMIT ;-:<^•,.;-a REP~pT T F';=1 "m~•t'. .. .. ... n~ ,... FPSLy rI°n41 <br />. LiIENT GRAS ~ L' 1 i,q` REQUIREMENT <br />~ TNgT l~:~$ Y~i=,7 <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 E%ECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY E%AMINED MD <br />MIUM VATH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDVALS IMMEDIATELY RESPONSIBLE FOR /` <br />t <br />II <br />' <br />ZIC{IJY4 OBTNNINO TXE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS / / / / ~ <br />' <br />~ <br />~ <br />. <br />~ <br />- TRUE. ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFCANT PENIV <br />TIE9 FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ ~,~~~ ~: <br />~ <br />/~/l .`( <br />- <br />- <br />_ _ _ <br />I ~'- ` _) <br />r".' 1 V I Yr"' ~ ° _ ' <br />' ~ ~ _ . <br />, <br />THE POSSIBILITY OF RNE AND IMPNBONMENT <br />SEE 18 U <br />S <br />C <br />f tOpl MD eS ~' ^ / , ~ 7 ~- ~ ~ OZ ~ ~~ <br />. <br />. <br />- , <br />. <br />. <br />. <br />c <br />f 171x <br />0.5 <br />MWei <br />M <br />m <br />h <br />A <br />e EIONATURE OF PRINCIPAL E%ECUTNE ~ <br /> . <br />. <br />. l <br />s m <br />rr <br />.r. mart.. our <br />, <br />c <br />. ~w. w ro SIO,OW AREA <br />TYPED OR PRINTED nM nurahlun inpi.ar.rrnt orMlw•m amanti+. A'M 6YPVal OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />GVmmcrylb ANU CA~Lgryglwry yr nm v1vL.nl wn~lneraronce en enscnmenrs oars/ <br />' L ~ - - . / ~ I ! a ' i r I , r T' '1 v ! _ .. ~ '1 r +n ^ 1: T `. , , ^ '. ^, c 1 ^ 1 T . ~ l . <br />s <br />Epp Form 3320.1 108-95) Previous editions may be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 ~ ,1 ., ., II ~ ~ n ~ j n ~ _ T ~ T' PAGE - OF <br />