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PERMITTEE NAME/ADDRESS (IKi/dl FerWry NandGxanm 1/D~inm) <br />NAME L :nn ~~~_ r. y ~(,' it .IY <br />ADDRESS :%~Al. II :J. ., i+1 fiL ' <br />NATIONAL POLLUTgNT DISCHARGE ELIMINATION SYSTEM hVROE$) <br />DISCHARGE MONITORING REPORT lOMRI <br />I1-15) /7-l91 <br />~.VvLJ L44~i~ <br />PERMIT NUMBER DISCNAncEH <br />..Ji~Jtk ,1. i. FN <br />~oUuN rC) <br />i - k'LEiA. <br />.a <br />Form ApproveA. <br />40-DO 4 ' <br />Approval yxpi~e4 OS-31-98 <br />-/'J .. i.l -aYl VV ~ Oj Y.3Y •111rT <br />MONI : G PERIOD ' <br />FACILITY MO DAY YEAR MO DAY y -- , <br /> <br />LOCATION FROM ^~,7. <br />:. TO j .. _ I ~ L : i ~...:n a..: ~ -_ ~ ~• <br /> Reed inrtructiont. bdon complelinp this form. <br /> x-151 !16171 l1s-1sl !34371 <br />t3 Grd Onlyl CUANTITY OR LO <br />PARAMETER !I Q.d Onlyl QUANTITY OR C TION NO. FREOUENCr SAMPLE <br />GF <br /> <br />146531 15b5J) l5s-5Jl EX <br />I38d51 !06531 <br />TYPE <br />ANALrss <br />l31-371 <br />AVERAGE MAXIMUM U ITS MINIMUM AVERAGE MAXIMUM UNITS [e2-E9l l545B1 !6370/ <br />~__ na.. .,nE,ASt- SAMPLE ~~.~{r044 ~ ~,.~ ... .. i::': t-. :,.:r.,. >.IY• <br />Y <br />: <br />i <br />i MEASUREMENT <br />, ; <br />L <br />r ~ <br />~4~., ,~ L, ~' PERMIT ,-, -.. ., _ .: <br />`,f... ~>:"O.X(~. ~~''' drGk-i, i.. 'r ~7~[3 tl <br /> <br />-kfi'J..a. YnLU <br />- - _ REQUIREMENT. ~ ~ <br />I: at [LA:.iC <br />t+u=0 - '"~ "' <br /> <br />. <br /> <br />' <br />~,,~ <br /> SAMPLE <br />MEASUREMENT <br />~ r <br />~ <br />- ~ ~~ ~ <br />\ <br />I (1 <br />~ ~ ~ <br />~ <br /> , .::. <br />, . .. . <br /> PERMIT ~ <br /> <br />~' ::~~:,~;, <br /> <br />~ ~:'F-:~.: , <br />--~. <br />. <br />.... <br /> REQUIREMENT .: ... .. .. ' :: ~~ .. : <br />~,;:; ,.. ; <br />. <br /> SAMPLE <br /> MEASUREMENT ' <br /> <br /> PERMIT ~ ~. <br /> REQUIREMENT ~ ~ "~~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> . . <br /> PERMIT " . <br />."F:: . ~ <br /> <br />REQUIREMENT <br />' . <br /> SAMPLE <br /> MEASUREMENT <br /> <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 CERTIFY UNDER PENUTY OF LAW tHAT I HAVE PERSONALLr ExAMINED AND TELEPHONE <br />AM FAMILIAR VJrTH THE INFORMATION SUBMITTED HEREIN: AND BASED ON DATE <br />(~ MY INQUIRY OF THOSE INDIVIOUAL9 IMMEDIATELY RESPONSIBLE FOR "' ~ ' <br />IEVE <br />IHI <br />I~Jjll ~~'~ ~ ~ 1-rA~ O <br />SAWA EEDTNAT THERE ME <br />- ~' <br />TA <br />F <br />A <br />I <br />T <br />/ <br />OMPLETE <br />I <br />M <br />RUE <br />ACC <br />URATE <br />AND <br />C <br />~ <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br />/7! ~ i 77,E <br />1 1001 AND 33 <br />BEE 18 U <br />S <br />L <br />1Tr OF FINE AND IMPRISONMENT <br />E P <br />BSIB 7 ~~ ./~ ~7 <br />I' i I ~ I `I FT , ~ ~ ~ ~ I . <br />. <br />. <br />. <br />TH <br />O <br />4 <br />IPSnmis Mlwr rASa annms mY /n<1P.1. tors up ro t lO,IX10 <br />S <br />C <br />1 r]18 <br />U $IONATURE OF PRINCIPAL EXECUTIVE AREA D <br />Y <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />sndamssimrn inpiawrrnr PlbwssnemonlhsAMbvssrs.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO A <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReierence elI attachments here! ~ ' <br />L-.., .~ L~Jlni ii~v'• il ii!.. nl:.:. bc. rRZVL:.F nVt_ ~:-~:':Lonl'1.:. -+_^i-~- i+.111 r.r rL:CJ k'C. r: ~=1uY n~CJHh <°':I n~-: k' YoAli <br />•TS~e ZhJ[: A\r _..i:L~Aa:.r. .+1.L.1G5 LZMiiS IiA1YG~ FLir. liV'f:,sLl•'[s a.icl.lr ~:V,:NI-A'.iAl;:: LGL:U11cNTATjOX-~11'. 1.As.i. <br />'. L : i .: w : e , ' rl .. 0 t - ~ . - ~ ~ r . • I • ~ t f ~'... t •I e : ~ 'f 1 v r ~ i ~ r ~ r :. I I ; T rt <br />EPA Form 3320-1 108-951 Previous editions may be used. (REPLACES EPA FORM T40 -RICH MAY NO BE USED.1 ~_ PAGE w OF <br />