|
PERMITTEE NAME/! 7ES5 perlWFrdlnNa/1.000lIw dDlGb++rl
<br />NAME .. , -.. ; .., I. '..., ~ .: ~ n a Y 1.. C .
<br />ADDRESS ~.,. i. ::6 : :. i ':.
<br />,% l( ;~I.i 1. .. Li~iAY 1~
<br />...:.... cu +.'.i:~lll
<br />FACILf1V
<br />LOCATION
<br />
<br />NATIONK POLLUTANT '^,HMOE ELIMINATION SYSTEM INPDESI Form Ap• •.ed.
<br />DISCHARG INITORING REPORT /DMRI OMB N< 30-0004 •
<br />1-Je, 17-191 ti I't' I '
<br />,~,t,~,~; ~: ,.. c / (`U;.i ~, ,. ;~~~ 'APProvel expires 05-31=98
<br />PERMIT NUMBER DISCHMOE NUMBER E. _ }~ ; ~ .: , -
<br />MONITORING PERIOD "' i .1 L' F
<br />YEAR MO DAV YEAR MO DAY
<br />FROM ',7 ,`/ :Z1 TO :i7 C9 'C .:.;~ ,. ;.t :.. ,i c, ., :.:
<br />/14111 l2I-231 111-151 l1G171 l1e-191 134311 NOTE: Reed InstrYeOarr balori eomlplatinp this corm.
<br />PARAMETER !3 OEd Onlyl QUANTITY OR LOADING !1 Ord on/yl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !/6531 15461 139-/5 /4653 /5/-611 OF
<br />131-371 EX ANALrsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (s1-s
<br />Tl
<br /> . 151-5e1 leg-701
<br />., n .:... . - .. • ~ SAMPLE :, .; ,; ::: ~::::: ( .1:1 ~ .. -t ;~ .; ~~ r, ; ;: t::5 ~ :: r::: i' :~ ~. ~
<br />
<br />MEASUREMENT
<br />~~
<br />~~"
<br />~ .I i
<br />'
<br />~
<br />. ,
<br />-.. .. '.~ i ,. ~ .. PERMIT ~
<br />:::.
<br />. :: K~ - ~ ~ V : c ~ :- t,' q1 rl r,, sy. _. r y..:; ~:
<br />
<br />., ..
<br />:. :1 ~.. , ~ , ; . ~ 1 ~ I I; .
<br />I REQUIREMENT. .. .. ~ , : ,, . ~`_ d ~ .• ` i .. .. ,...: r ... .
<br />1
<br /> SAMPLE
<br /> MEASUREMENT
<br /> : PERMIT ~: ~ . ~ ~ .. ... ~ .
<br /> .REQUIREMEN7~ ~ ~ .. ~ .
<br /> SAMPLE
<br /> MEASUREMENT .
<br /> PERMIT
<br />~ ..
<br /> REQl11REMENT
<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 /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT~~
<br />.. ~ ~
<br />.. ~ ~ ~ ~ ~~
<br /> REQUIREMENT ::~ ~ ~~ ~ ~ ~
<br />r
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF L
<br />AM FAMILIM W1TN THE INFO AW THAT I HAVE PERSONALLY ExAMINED AND
<br />RMATION SUBMITTED HERDN
<br />AND BASED ON i ( TELEPHONE DATE
<br /> ;
<br />MY INQUIRY OF THOSE INDINOUAL9 IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATON, 1 BELEVE THE SUBMITTED INFORMATION IS
<br />TRUE. ACCURATE AND COMPLErf. I AM AWARE THAT TNERE ARE %~ a
<br />_ -.--~
<br />~ ~ `' (I~ < L:"' "
<br />
<br />SIGNIHCANT PENALTIES FOR SUeMITTINO FKSE INFORMATION
<br />INCLUDING _
<br />
<br />' ~
<br />: ~
<br />~
<br />~
<br />\ ,
<br />THE POSSIBIUT\' OF NNE AND IMPRISONMENT
<br />SEE IS U
<br />S
<br />C
<br />1 1001 AND ]7
<br />! ~ ~ ( ,; ~~
<br />
<br />~-
<br />I I
<br />(
<br />:
<br />.
<br />; . .
<br />.
<br />.
<br />. ~BIONATURE OF PIIINtYPAI EXECUTNE ~ ~ /
<br /> LLS.C. 1 tSU. (AVrtln rW N.. mnnw .r.Er ~. Aiwa rq ro 110,000 AREA
<br />TYPEDORPRWTED r/al rrraeimrn NrAdda+r+rNMnr«n sma+Nr rM BVraI -OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />a,vmmcn I a nnv cnra.nnn I Ivn air nnr vwLn nvna Inogsnce an eRSGD/nmo nerq
<br />.~_....,,.. ....~ .. L1.... ,~.i.l.l..., L.,.i Cr <_ ;-°. :, .- . :If -,..r.ClF FVE;;'! l`. 'L~ft .. i.. .. .. ... .. i
<br />,, , ... ..-.:i~. ,!L.. .;:1': .I .. . .. dL t.:~ Pv f; h. :' :1 i. i; r'i nSCG:i htf.^
<br />"
<br />_~~Ek. T
<br />. h
<br />i
<br />f
<br />,i I
<br /> .
<br />_
<br />_
<br />.
<br />,
<br />.
<br />.. .: .
<br />EPA Form 3320-T 108-96) Previous editions mey be used. (REPLACES EPA FORM T40 WHICX MAY NOT BE USED.1
<br />PAGE OF
<br /> _
<br />
|