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PERMITTEE NAME/ADDRESS ! /nr/ude <br />Feriliry Neme/Loruion i! di!lercnrl <br />NAME <br />ADDRESS ,. <br />--E-J-,F/c-~--~Ti--------------- <br />FACILITY <br />LOCATION <br />- - - - - - - - - - - <br />e'P'P I~ . v r <br />NATIONAL POLLUTANT OISCRA RGE ELIMINATION SYSTEM (IV F•OFS 1 <br />DISCHARGE MONITORING REPORT l D,tifkl <br />(?-161 ! 17-191 <br />IPEAMIT NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO _ <br />I ' -I i~1 ~t' <br />r.n-Jlr r,,.,;1 r.J.sl Wean (~sacl I~n:1il <br />I ' <br />Form,};pproved. <br />7 OMB No. 2040-0004 <br />rrtL <br />,. )iL-` ~ ,.AQprov~IRxP;res.~0-~1-~84.: , <br />NOTE: Read instructions be9or~ CURlpleting this form. <br /> li CJN OnIr) QUANTITY OR LOADING (J Cdrd Onl}'1 QUALITY OR CONCENTRATION <br />PARAMETER (Jh-r:) (jJ-ell r.iS-451 (Jb-i_i1 (.i J~b 11 NO. FREDDU`NCV SAMPLE <br />TYPE <br />!J?~t]) E% wlJwv515 <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS I6?-o+1 IM1a.M1,VI In d~lOr <br />FLU~N <br />Iii C.)-i JUI_ ):' SAMPLE ~1 <br />I ~ <br />....: r ..:... <br />~--~ ~-~-~- <br />..:.... ... ... <br />- ~~~~~~ ~ <br />. ... .-.. . <br />... <br />~~~ ~ ~ ~ <br />r MEASUREMENT . <br />1 / 1 I <br />T9kU Tt:~ <br />:s;' -:L_,~: <br />;'tt U1 <br />.. <br />. <br />7UQ 5'J L U J PEP.MIT L.4r~ r':;:'Lkf <br />~ :. ,: ~~~:: .... ~- <br />~ ~ <br />~ ~~ - - :-.Yt.Y <br />' a"`=. ti <br /> REQUIREMENT <br />L ., I 11 y <br />SOLIU~r Tl'~t?•L <br />....:.... <br />;....v .. .. <br />.. <br />..... <br />~'.,: yl _:. ~ l~) <br /> MEASUREMENT 3Z <br />III:~JJLVE.J <br /> <br />7V~75 L O ~ 'PERMIT 1: ;i qv Wit: o;: 11 :: ~C: [ :;[ f -. .. ~p'['i l;(1' ..tTT'1:~~( 1? <br />LY ;::A!3 <br /> REQUIREMENT . . <br />1 C' <br />w t' 'P ~ P P, <br />HLII ~.UnY <br />'LJ Cr1 .. SAMPLE ~ .. ~ ':J~ <br />~ <br />QJ UI~~ <br />~ MEASUREMENT ~Q ~ i/ <br />. <br />~1y(]J L '~ V PERMIT . ..:::[-^.~~ ~-. r.': :F :: Y:'; f: o: ':>i': r~:;: I%.~I LI ~:V7 At C''J f+'1 <br />~ .... w~ r.l~~ <br /> REQUIREMENT . - <br />I, I V _ <br />I <br />rl . t v . 'r <br />., r , <br />OIL /11J O v)'.:. ~..r :. SAMPLE ....: -. : ~ '1 y ~ ........:.... ..: .: .... ~.. .. .: <br /> MEASUREMENT <br />I <br />VI;;G6L ~ ! <br /> <br />tl~VOJ L !~ .I PERMIT :::: :: ~:+° O t..r=~. Wrj::;t :}: ..- ': :::: :::~~ ':~#L::]:: : : ::'~ ~F,:y Y 'r_iU 1• <br /> REQUIREMENT <br /> <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 EXECUTIVE OFFICER I CERnvr UNDER PENALTY OF Lqw THAT I HwvE PER50N4LLV Ea4Mwe0 <br />F <br />R TELEPHONE D A T E <br /> AMILIA <br />qND AM <br />WITH THE INFORMATION SUBMITTED I-'EREIN. AND BASED <br /> ON MY INOUIRV OF TFiO$E INLYVIDUALS IMMEDIATELr RESPONSIBLE FOR <br />~ <br />D ~ <br />, 1 Q ~G <br />(~ CB'<tnl^:C SHE rYFORM4T:pN ' BELrEVE '^ SJ3M TTED IhF GRM4TIDN i$ <br />E ACC <br />RAT <br />AN <br />P <br />~ <br />R <br />P J <br />~ <br />' <br />. <br />r <br />wW< <br />i <br />U <br />U <br />E <br />D COM <br />LETE I <br />E TH<T THERC 4RE <br />SIUNIFIC>Ni PEN4LTIE5 FOR $UBMITTINLAFgLSE INFORMATION INC <br />DING - <br />~ ~ <br />.. _ <br />' <br /> LU <br />THE Possl6lllrv OF FINE AnD IMPRISONMENT SEE Ia use 4 Itbl qND <br />3i USC I '319 /PrnJlllrS Yn~[r !ll[Sr ~(JlulfS n[ludC rnl[a Y <br />1 l(r <br />~ SGNATURE OF PRINCIPAL <br />%ECUTIVE <br />TYPED OR PRINTED ~ <br />510.00.'1 anJ nr nu~~mum Imonsonrnrnr u! hnwrrn M1 mnnJe <br />und 5 fun I OFFICER OR AUTHORIZED AGENT M R AR MO DAY <br /> CODE <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (Re/brnir all J«dcnmem< hurl <br />NIiiS:;R M05 L1'Lini:14 ~:\:. r..'~cJ 'w r!~t7 1CC .. -, _, "nY CF. aAi: ?. .'UUU~ ;li U:':: :: i':'O:i :~ 3Ci.4 •_H ~TC'C" •1 :. f+" , ~U"^. .. T <br />:T.; "I v. <br />• 11HTRLY SdMPLI:+~ Ir!_?.,UCT:...._-_....r, P!'. '?Ii. <br />Form 3320-1 (Rev. 9.88) Previous edl(ions may be USed. IREPL ACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF <br />