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I'ERMITTEE NAME/ADDRE551/rlflul/r NATIONAL. POLLUTANT OI4GN.\RGE ELIMINATION 6T STEM (NI'DtS ) <br />l ari/iry Nxrue//ur.riun /! di!lavrnll DISCHARGE MONITORING REPORT (OM1/R ) <br />NAME 'i ?F ?Cl :'lif .:(1_-'r •iT ~D TT A:r'J~ f!-Ihl (N 191 41'Jar• <br />4 <br />OORESS,...~Z 1~.~LL ~.~~.?--__ _----_ (~(1 /.~~717 .'1.4 (-1fyR ~~( T~.1~~PrOVBd. <br />, <br />_ <br />_ _~,~ yj P ~F' _ _ _ _ -_. _ _ 7 '~ '+ S 1']1 _ _ PERMIT NUMBER ols~~a»o~ R..ec• ~ <br />- FL N { r, OMB No. 2040.0004 <br />.1 C17 ~rv y^T [f1PW, P+h?IegWI1rS11~0'3j~;, <br />MONITORING PERIOD <br />=AGILITY IITT ~j (I~' YEAR MO DAY YEAR MO DAY <br />_OCATION We 1`01n%A.I. E.C C~i~SO~) --_____ FROM /. ~. TO 4 ' .-.?;': 4f~ 7I ~+lA~(: ': ( #vi <br />+n NOTE: Read instructions befor ompleting this lorm <br />zu 'l l <br />t <br />>>- <br />+ <br />ze-?~ <br />>a-?s l <br />r'a-~9 <br />/U <br />' !':I <br />? <br />~ !; ° ; I ' <br />' <br />i `+ T <br />. <br />_ <br />_ <br />l <br />l r. <br />r <br />: <br />r <br />r <br />1 ( <br />I <br />. <br />. <br />: L 1 <br />~, (.1 ('drJ Oull' 1 UANTITY OR LOADING (~ CarJ Oul) 1 QUALITY OR CONCENTRATION <br />PARAMETER ~ lah-!+1 (~J nll (td'-J.91 f~o~f l/ (SJ-nll NO. <br />EX FREQUENCY SAMPLE <br />(t!-.I?1 Arulrsls TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS 6J <br />pl <br /> <br />~ 1 <br />I <br />- <br />f~V~681 <br />f09-lUl <br />_ <br />I,~`Ye 'i'ra "hll 'Iu t.1 {~: <br />r SAMPLE r.r ~. ~. ~... ,•ti-• ( Z3' <br />- J' r Jn~ 1'1 rr 1 ~ MEASUREMENT <br />~i'1:53,: ] ~' .. PERMIT v'rdk#~": •Yr•:># ~• R?P011.' r#'.;~:# #r3;:~k ,':- TRL'( RAB <br />P~FLII?ar ::s~;~ V1LI1: REGUIREMENT •:~I:i '16 DAL11; CF'VT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REGUIREMENT I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REGVIREMENT ~~ <br /> SAMPLE <br /> MEASUREMENT ', <br /> PERMIT ~ ~ ~: <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br /> REGUIREMENT ~ I <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT <br /> <br />REQUIREMENT <br />~ . <br />' <br />NAME/TITLE PRINCIPAL E%EGUTIVE OFFICER I cERnEr UrvDER PENaLrY OF Law THAT I HAVE PERSONAUV EYaMINEQ TELEPHONE D A T E <br />_ AND AM 14MILIAR WITH THE INFORMATION SU9NIL LED HEREIN 4ND BASED <br />\C p <br />, Q ~p~ <br />~h~ rNJ MY ~NQURY OF TrgSE INp VIDUALS IMMEpATELT FESPONSIBLE FUR <br />OBIAINIM'. THE INFORMATIgJ 1 BELIEVE ME SIIBMITTED INFORMATION IS <br />J <br />o <br />\ INUE aCCl1RATE AND COMPLETE I AM AWARE THAT THERE ARE <br />SIGInFn-AIL! PENALTIES FUF SUBMITTING FAI SE INFORMATION INCLUgNG <br />` <br />` f <br />QL <br />r/ <br />! <br />KV d V ~ THE PosslRlu rr of FwE AND IMRU150NMENT SEE I6 usC f loos AND <br />-3 use f ule <br />uuun m. <br />'nduJe l <br />/~nalbe <br />nJ <br />rh <br />re <br />t SIGNATURE OF P NCIPAL EX CUTIVE ~ 3 <br />~ p <br />b <br />( I I~ I <br />IY YV <br /> T <br />a u <br />a <br />uc a <br />u <br />o <br />. uJ <br />1 <br />f <br />OFF <br />AGENT <br />C <br />R OR <br />AREA <br /> TYPED PRINTED fIU.IMM) anJ nr uN Vmua. m9niwnnaul m Pnurru n mrntlu unJ <br />Inral I <br />E <br />UTHORIZED NUMBER YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS I Rrli•rcnev all alld['hnllnU hrnV <br />.:d ".li:'! 'i, l %'l :. A4,1[•.i li ;}.~. F'R!1^.~'!+11^.". aIIP L')I{P•;•l' i)Tr.fl?'I)Y (Y~ ?Y''L0£VT- ~iLTC'!1 Ti TH!IL TO <br />'".)t )P ~2 7!7.+.JIS"i (L"1 -1) p.yD rTTsf''I {I'nr(? TOK~"'1 T4:.'C'r 3"[1:1* ~'OF'1 '"') 11:1R• "D"fF.ti ')F A~ <br />I ..1 .1 1 r r I .I:I' .... .. .. ~ <br />