PERMITTEE NAME/' -RESS R,,,i,t.FrWryNs,/Pocanm yD,p..ap
<br />NAME ...:: ~.. ~ ,.:. L. .. i','i. r. 1 .. .
<br />ADDRESS L:) „'_: ., ~ :. . 1 ~. -
<br />t: ; , ., I . ~. 1
<br />FACILITY
<br />LOCATION
<br />I. I1 r
<br />NATIONAL PDLLUTAN' -'-CHMOE ELIMINATION SYSTEM (NPDESI Form Ap~-•ved.
<br />DISCHARF )NITORING REPORT (OMRI 1 / ;OMB N, 40.0004
<br />1-/6. I7-191 """ '' ~ Approval .,xpiree OS-31-98
<br />PERMIT NUMBER DISCHMGE NUMBFA ~~
<br />- , '! :.
<br />MONITORING PERIOD N ~ ~~ i' `'
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ) ; :'; (:• I. TD ' 7 7 ? .i : :: n ,' : '., ". r '. .: r ;
<br />l10-III 111-131 !14151 !1617) l19-191 13x311 -INOTE: Raed InetNalane belori Z'otripMtlnp~thie lorm.
<br />PARAMETER 13 6/d Onfyl QUANTITY OR LOADING !I Grd Ontyl QUANTITY OR CONCENTRATION NO FREOUENLY SAMPLE
<br /> 4653 !5461 /39-461 14663 !51-5/ OF
<br />l31-371 EX MALysIB TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /SI-S]I /~~) 169-701
<br /> SAMPLE .. .. . ,; {;.,y ::I / I ,.
<br />"'/
<br /> MEASUREMENT
<br />, . „ _ PERMIT' :: r,'. ..... ::, ' k ? ; q ~7.. n ,
<br />'"
<br />i
<br />°
<br />' I
<br />, REQUIREMENT ~ _ ' .
<br />r
<br />.
<br />i I . F T
<br />a. n + I, i
<br />~
<br />'.
<br />. ...:.,, .. : ''1. SAMPLE .::: ::::::~ r, :};:~+:~ ~ ~
<br />L .)
<br /> MEASUREMENT
<br />. „.: ;. :i C r..
<br />'t, ::JJ ,. ~l
<br />~~ PERMIT' ~ .;.I}{::;::;.. '~,: :.
<br />~
<br />~ is ': /j if .'.~,; ~ 7e~. ~ ~ )c'~ 1
<br />'i ~.
<br />, i
<br />.n.
<br />/ I,II ,, r' 1. I~1 ~. I.ili
<br />.. ... , REQUIREMENT'
<br />
<br />~ _
<br />1: :'/
<br />.•
<br />1^E Y /r .
<br />J.,
<br />•,,.~::., ~'. 1,. :~..~:.; SAMPLE :; (n;::`:;:;p :: ;::;: {:. .. K: ::O:;:;.7 .'; :/:]+: :} .
<br />( ')
<br /> MEASUREMENT
<br />~'J i .. ~ PERMIT .:: ¢:;: ;: ,«r::: ~: .... . ~: ,1 :} ,} b f,• C C~:: f
<br />l ~ ' ~
<br />i ~.
<br />~ .i I :
<br />r I. J; REQl11REMENT ~ ~ ~ .
<br />.
<br />•.r ~• I , ; .. n
<br />_
<br />~'' ::. :... ..:. .: :. .:
<br />' .~ SAMPLE ;. ;: :::::,:.::: :.C ;;,; r, :. :: ,: ,; :.' )
<br />'
<br />" ' MEASUREMENT
<br />r I;
<br />' •. .; 6-', r.
<br />. : i :
<br />..: ~ :: r, i ~., PERMIT ~ .~ ::. ;.. L::: :............ :.
<br />..... , ; ;';: ~r: ;: {' 0 n. 4 :7 Y C e7 Kn ~ :
<br />!'~ -
<br />1
<br />1'
<br />'
<br />
<br />REQUIREMENT
<br />~ .
<br />!
<br />- .
<br />- I .
<br />1
<br />..:',, "'): :.I SAMPLE ::ol : K..;..:: :.:?:7 :: : ,? I i)
<br />(:... ~ : )
<br />MEASUREMENT
<br />_ .. .. :' ~ ~ PERMIT ~~. :. ;,:: ;::;~;: .. ;:~,: ~~:C .. ;I q~;..y' : c
<br />3 7
<br />~' / r ,
<br />,, ~
<br />i. t%
<br />' REQUIREMENT ~
<br />
<br />~ ~ ~ .
<br />~ r E .
<br />r ;
<br />r ~, .
<br />i
<br />. _.. ..1. I': ':!' iii SAMPLE (
<br />.13j ::. ,; n:; ,r .7 •'. ~~::'~: ~;
<br />.~ ..
<br /> MEASUREMENT
<br />
<br />_ ,,, ,. ,. PERMIT 11.,1. :.i~l ,'; :1L it (:Ui:,°' f,'y, :}s`. Y,, >7: ''}:, • .. ~ '~~ i./
<br />'
<br />6, ~, REQUIREMENT ?;i i,
<br />t: ~I
<br />l'
<br />Y 't ''~
<br />,
<br />.. : , r
<br />. .,:.. ,
<br />I c, , _~'' i i
<br />L • SAMPLE ::+: ~.:::::: ::+ ':~ ~~ ~ :.:;: .; :i ;.:7 r. i, :; ~/ )
<br />~ MEASUREMENT
<br />, : !
<br />./ , ~
<br />/,.:~;, ., ,.
<br />~ ~PER.M.IT 'r;v:::4;::;~:..~ ..::.:,:;: .. I;r,.i;:7,.c . t~F1rL'NA: ..`1.':''`. ~ I'::L'i ,; :'
<br />.
<br />' ~
<br />'~ !
<br />~
<br />,,
<br />'
<br />:i :. REQUIREMENT .:. .. . .
<br />,
<br />„
<br />.
<br />.
<br />. ~
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cEATI
<br />AM FA FY UNDER PFNNTY of uw THAT I NAVE PERSONNlr ExAMwED MD
<br />MILIM WITH THE INFORMATION SUBMITTED HERDN; MD BASED ON ~ ~ 1
<br />I TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INOINOUN.S IMMEDIATELY RESPONSIBLE FOR ~ J -•.
<br /> OBTNNINO THE INFORMATION, 1 BEDEVE THE SUBMITTED INFORMATION IS j/ r ~ -' :r ~
<br />I j{- ~ - """'
<br /> TRUE. ACCUMTE MD COMRITf. I AM AWME THAT THERE ME .
<br />- / ~ /. ~ '
<br /> SIONINCMT PEMALTIE9 FOR SUBMITTING FALSE INFORMATION
<br />INLLUOING
<br />f
<br />~' ,
<br />THE POBS
<br />RISONMENT
<br />BIUTY OF R
<br />BEE
<br />B
<br />S
<br />MD ]] ' " ,'j ~ ~ I
<br />_
<br />I
<br />; I I
<br />ME MD IMP
<br />.
<br />1
<br />U.
<br />.C. E 1001 61
<br />ATURE OF PRINCIPAL EXECUTNE - ( 1 _
<br /> U.S.C. L 17U. /P1YW.'MA Yldr 6wr mvNa ,ruY IrrA.OF A,.F y ro f 10,000 9 AREA
<br />TYPED OiI PRINTED rWrmuLnun inalonr~NWbmw, envrNa rW 6YAVa/ ..OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference e//effechments here)
<br />~i_1!L~:. ..... ;!..., if~.ii '~i':'L!~.~ .,:,Lf _. .= i:i-~('., ,'1, _,:r ai~. FCIF EYf1iT ;°_ r1~Il'. ! ,. .~i,.. .. ~
<br />_ ., .... ( -.. ... L.. i'. .. .:ILL ,}1.1T .. d!':'i. i. :. .. P(: .11. i'C%:i..L r!~ d ill !i~PE1•I 5°-'`°:;c l.. i 4, 11 l,' ., 1 1•I .
<br />EPA Form 3320-7-108-96) ~ Previoue~editiona may be'ueed. - ~ IREPLACEB EPA FORM T<0 WHICH MAY NOT 8E U6ED.) PAGE OF
<br />(7!;(1,15/`:71i!.~~-~.:-:1'L '
<br />
|