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PERMITTEE NAMEIASllnrhdr <br />!'rrlliry Nrmr/LOmrlon 1/dU/nrnll <br />NAME_(..r1L::J.IiYCLIJ~•i.l. ~'11~F~IL'L- --- --- <br />ADDRESS('fl l.ill~'~"~J~/~1,~'--_-______ _ <br />-- - YZ 31 S'LA Ti 11 Cs;AU.i: AY 1.i_-- - _ . - <br />NATIONAL POLLUTAHARGE ELIMINATION SYSTEM INPDES) <br />DISCHARD NITORINO REPORT /DMRJ <br />11-16/ l17-Iflj <br />' 1. I[. (}~1 T I fll <br />PERMIT NUMBER DISCHARGE NUMBER <br />F - FItI:tL <br />F approved. <br />fA~Al~o. 20a0-000< <br />Approval axplrel d30-91 <br />(i47D St;;': <br />-S"t~"'t.ti'---------Lt1-;u41L-- MONITORING PERIOD <br />FACILITY __ _:__ -- __ ---- -- -_ YEAR MO DAV YEAR MO DAY ~~ <br />: <br />LOCATION--- ----_--_--__ FROM I TO 1. f.I .•`71T (`~!1?k ;i4)' [r `1 }'A,T <br />ti • A. 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'~ti.- : O C +:, '! tt r] I <br /> ` <br />Low <br />IN coR na t'r OH SAMPLE ~ 1}:;: 1}I(: {A# Y 1 ~l ' ,Y[T ~Y I([:1 ~(c '.. i fj :}lt i:::[ ::: f,:r{Y,t T,: <br />, <br />I'llRll TRF <br />ATHENT FLA4I MEASUREMENT _ i ,! ~ <br />, <br />S )11~iU 1 U n ~ <br />- PERMIT .: "#Y}##%!#, r t_,'AP.,PQA~ u uny~ <br />/~ ~#,~t144 .#~At:YfrA r,:,: BEIfLY WSTA', <br />~ REQUIREMENT ;~ L ~ <br />~ ~ A 4 <br />:V <br />: K i <br />•)LIUSr TO PAL - SAMPLE il:<:1t`TY,:_ f.T:fY[#'k :[ - _ S4'r>k:}::~ !;.C(e::#.% I ' <br />{ <br />' <br /> MEASUREMENT <br />50LYEU .. <br />lC: <br />1 <br />1'3)'17. 1 0 P PERMIT `#b:X#t:f1 <br />• <br />^^ :~rA9#7~Llf' :[:.`•: ., ? ~+!Po~b#~ ~ M-'.=:Y~t[~i4b' HEPOR`P - ~' ~RLY l HAL' <br />~[, ~ ~ -I ~~,- ,~T ~I REQUIREMENT. - 1 ~ <br />. <br />y ~ 4' , ,,:~"y. ,. n .. <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF UW THAT I HAVE P ERSONALLY E %AMINED ,TELEPHONE DATE <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTE D HEREIN; AN D BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATE LY RESPONS IBLE FOR ~ ' <br />' <br />_ <br />ATKIIVSON - <br />H <br />G OBTAINING THE INFORMATION. I BELIEVE THE SUB MITTED INFO RMATION <br />. <br />. IS TRUE, ACCURATE ANO COMPLETE. 1 AM AWARE THAT THERE ARE 510- <br />VY LANll/EIVVIRBNFIENTAL AFFAIRS NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1S U.S.G. ~1 1001 AND $IGNATURE OF PRINCIPAL EXECUTIVE ~' <br /> <br />TYPED OR PRINTED JJ U.S.C. ! 1]18. /Prnrllia under Ihrx ,mrvrm may iMludr Jlo uP [o !/0.000 <br />and or marimum imprironmrnrd6rlwren6mmr/urnd Jymrs.) <br />OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />tEAR <br />MO. <br />DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS /R~frmrn all ottPMmenu Arrtl <br />F~JR JIL 'r GRF'0.5R, ~F,F FUQPt17T~ !'/ IV 1'HE fF!(H!':. SF:'I'TL};0.PLE: ~ULIi)i ?}.'T 3F(•IIF.E{I tl^LY IF <= lU-Y n, 211-'~ ~ <br />i.dEC[P L'lFHT C'LAIM(:D. IF' `"Ldfy ~F~urly!-i, ., y ~tir~'I, f:S t: r, :1! I f"1'f; dTf.i, tl,r.. ;I, d.r?.FF'h Tn !jci.lv9r:it <br />EPA FO 20.1 (ReJ, 9-8(1) rev/dua edRloml may be Wed: "'"' IpEPU1dES EPA FORM?-Q WHICH MAY NOT BE USED.) PAGE OF <br />.I loll /'il.l: "1_ :~~!. ' <br />