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PERMITTEE NAME/ADDRESS psY4 faWryNrWLocenon UDNGrq <br /> NAME TkAPPPR ".INIR^, Lv~. <br /> <br />~ ADDRESSTHAPPPR I!CyR <br />~ D.O. ?7X 1P7 <br />~ CitALL: C~ HT526 <br /> FAal.m <br />~ LOCATION <br /> ATTN: 4. ;;DRD'J±7 Pt'TF'R:;, P?SS/GEtl (7G3 <br />j PARAMETER 13 Gre On/p OU. <br /> 146531 <br /> 132-J71 <br /> AVERAGE <br /> ~• ~ ~ ~~ ~ SAMPLE 'f^ <br /> Y [ SU A :. MEASUREMENT <br /> <br /> H4U66 1 v D .';';:PERMIT: <br />' f .... r,[}t <br />:' <br /> <br />e,'FPLUA'~T ::HJSS VRLU. . <br />.. <br />..,.... . <br />~REf1UIREMENT;. . <br /> <br />,.....,' <br />~ <br />NATIONK POLLUTMT DIBCNMOE ELIMINATON SYSTEM /NPDESI <br />DISCHARGE MONITORING REP011T /OMRI <br />2-I61 ' 17-791 <br />..D <br />PERMIT NUMBER DISCHMGE NUMBER <br />FROM <br />MAXIMUM <br />TO <br />UNITS ~ MINIMUM I AVERAGE <br />Forrn Approved. <br />• T N ~ ~ OMB No. 2040-0004 <br />S (~ n>; a y~ Approval expires OS-31-98 <br />tr - FT F: Ar M~... , <br />°7N^ !S TC NO VA'1F. GOLCR <br />NOTE: Raad ImvucdtNr baima coNlplatin0 this form. <br />CENTRAT1~611 ND FREOOUFNCY SAMPLE <br />EX MALV51$ TYPE <br />MAXIMUM UNITS ,.,_.., ,~, ~., ,.. ~,., <br />;.: <br />es=i <br />.;...... <br />:. <br />~..... <br />~,i, <br />/T: I:::. '..' ::..::'~'.I~ :.:.: <br />3i. ~~~'~~ '-, <br />'... . <br />.:.::..... <br />..:. 'i':.'.: ~.:.::: ~:.:.:.: .. .. .....: ..:'::' ::...".'.: '~.:.: .. ... .. <br />RE UIREMENT: ':. ':':::' ::::::::. .: :.:::: iS..`..:':: .. ,:.., .:... , ,........:: <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDEp PENMTY OF LAW THAT I HAVE PERSONALLY EI(AMIF/ED MD TELEPHONE ~ DATE <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MO BS$ED ON <br />MY INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY pESPONSIBLE fOR I' /~ <br />fd. Gordon Peters OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~~L • ~ 70-H24-4401 UD 1 2i <br />TRUE, ACCURATE MD COMPLETE. I AM AWME THAI THERE ME <br />esider.t /General Manager SIGNIFCMT PENALTIE4 FOR SUBMITTING fuSE INFORMATON, INCLUDING <br />THE POSSIBILITY OF NNE MO IMPNSONMENT. SEE 10 U.S.O. E 1001 MD 73 BIONATUIIE OF PRINCMAL EXECUTNE <br />u.s.c. E t st a. rANlw.. r..er IMr .sem. re.r Yrh,r~ r.,.. w ro C /0,000 <br />TYPED OR PRINTED .nswmrhxnrhwbarnwrcWMR.rn•mme4a rW6r.Frsl OFFICER OR AUTNORRED AGENT coOE NUMBER YEAR MO DAY <br />CO MENTS AND EXPLANATION OF ANY VIOLATIONS (Ra/rrancs a!l ertschmnts hare/ <br />:SS E Tn~AL IRS: L.TPI"'~ TILL. Rti ~TAIVED, AND SESTLP.APL°. 5'~LI'.1S LI?!T* AnPLT°D >:~a C-1;1y~~~~gtrn ppcC~p yyPy/T_ <br />~3E tiURD'dN OP P+OOF R?QULRP.~tENTS URDER 1.A.3. PERRI!*P,E r.DSr TARE At.t °P..ASO'+ART.~ "*'ASr,nrq Tn RppOCF P11 <br />?N ACCORUANCP. NI7H REST. R;.RT PRACTICP.S -~~E-L.A.S. iD5 !!O~iTAR~Mf - LR.3 <br />EPA Form 3320-T 108-951 Prevloua edmona may be used. REPLA4g6 EPA FARM T-4 W A~~ 6~ 9S D.-' n oo a 2 ~ 9 9 Q 4 ~/ 1- t n 3 9 PAGE ~ OF <br />