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PERMITTEE NAME/ADDRESS p.d~1. Fsdlry Nw/Lor,nan Ifotp..sp <br />NAME. POHDi.ELHOk:r' CGAL COMPANY <br />ADDRESSRJACSIDC 'il7r, :i PGh^.'ALS, <br />P.O. FJf 1:3' <br />PALL~AL*.: ~_ dLSli <br />FACILITY <br />LOCATION <br />.4T'I:t: JUr1h A. .i~'%!A3- F :::iiLE67 <br />NATIONAL POLLUTM7 dISCMMOE EDMINATION 9YBTD$/NPOES~- <br />DISCHARGE MON170RING REPORT /OMR1 <br />1-f61 I7-191 <br />' 14 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FRDM O S Cl O 1 TD O 1 0 3 31 <br />1161/1 111-131 111-161 I1G171 119-191 130-311 <br />Form Approved. ~' _ <br />POYD 2 TO COLORLD~~3°~(($Dr~DOO ' <br />{SU9R IiC) PPr i'~`°3ugD9~>v:~ <br />is <br />F - FI t;AL `` <br />„IrOR .";1.~~ ' <br />W, <br />r ~ , . <br />t'°~' q'J U~SCHAkGE Y'" <br />NOTE: Rsed netructlorq befog pletinp thin form. <br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !/ Grd Onlyl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> !46531 l546f l38-451 !4653 l5L6I1 OF <br />l31-371 EX <br />MµYBIB TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !a1-a]! 164-581 169.701 <br />1L AhD GREASE SAMPLE '.: t~0 ::=': ( r~L(~ '.-4: ;t IP Y~ -: v~trit'.- #~L'; #:`• <br />V I S U A L MEASUREMENT <br />:40b6 1 U U PERMIT . m~r~TC#>~ iIEPORT E5=1 r~###p ~~~### a~~~u~l sac ESri~LY ISUAL <br />.,k'F'LUENT GRUSS VALUE REQUIREMENT y N - 3bii+ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ' <br />- :REQUIREMENT ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />I. <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 />NAMElfITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I HAVE PERSONALLY E%AMINED MD TELEPHONE DATE <br /> AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN: MD EASED ON <br />~J~~ Jf r MY INQUIRY OF THOSE INDIVIDUALa IMMEDIATELY REBYONABLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT TNERE ME <br />SIGNIFICMT PENALTIEa FOR BUEMITIING FALSE INFORMATION <br />INCLUDING Lq <br />9 <br />/` <br />/I <br />j <br />~// <br />J <br />~\ ~ , <br />T <br />E POSSIBILITY <br />F FINE MD <br />PRI <br />ONMENT <br />E 18 <br />S <br />L <br />D 77 / /G , <br />/ <br />G~ <br />+~YJ / ~ <br />l l C <br />J <br />.~ r r . BE <br />. <br />. 1 1001 M <br />H <br />O <br />IM <br />S <br />U. SIGNATURE OF PRINCIPAL EXECUTIVE , <br /> <br />~ U.S.C. E 171 a. IAVrld„ urpw VI,M mem, wr,Y iicAd, m., ~ ro t 10,000 AREA <br />~ TYPED 011 PRINTED wwwrAirrlm YnA.rsrnrrr etbnr,n en.cnm, rNerr-al OFFICER OR AUTHORRED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference sl/ stteehments hers! <br />~i::TTLEA9LE SOLIDS LI.";IT APPLIES UVLY LF <=1UYR,2LLt{A L'dcCIFITATICti EVFh? iC CLAIMFU. FFF?IITTFc' nAS <br />~yU!iUtiN Or' F'POOF f:HEN RS~UESTING Rr".LLt:F FAOH :;ETTLEA9Lc SJLIp_ PAIP4RY LIrtiTATIr%65. <br />EPA Form 3320-1 108-951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 C C ti 1 2 / Q 9 L ].[ ~ - 1 2 S E PAGE ` OF <br /> <br />