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PERMIIIEE NAMEIADPO~5511nJu/r NA bONAL POLLUTANT HARGE EIIIAINAiION SYSTEM INPUESI • <br />l..nq~n'amrH.nronao J DISCHAR ITORING REPORT (DA1R/ <br />NAME-I7~~ ~ (NIICi-~~j,fl~--_ /1-16/ /I7./9/ F - FINAL <br />cnJu sa- ~~ <br />ADDRE55 ~~~~.~ ~~~ -- _ -___- - ~ STORRyATF.R DISCHAP.G3 <br />---E,LA/=STlrp -----_~~~jnni - PERMITNUMBER DISCHnRGE rJUMBER <br />.__. MONITORING PERIOD <br />FACILITr <br />-------------------- YEAR MO DAY YEAR MO DAY <br />LOCATION---- <br />---- <br />--_--_ FROM TO F11dO$ HVTRS <br />- <br />-- <br />' u• D°'!ti S STE Y, NSON pRES EN /7o-zll Izz-z3) IN-SSl Ize~z71 Ra~19) Oo~i// NOTE: Read Instructions 6elore completing this lorm. <br /> O Card Only/ ODANTITY OR LOADING /a Card Onry'1 QUALITY OR CONCENTRATION NO FeEOUEr+G+ SAMPLE <br />PAgAM EiER I<JFJJ/ IN~61/ lJ8-e5/ I<6~53/ lSa-6l/ EX of TYPE <br />1.+. ~JIr AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />167~6J ANALYSIS <br />Ibe-6al <br />169701 <br />riI SAMPLE ~~'. +'-i,'F# ##%rviif ##### <br /> ME4~UREMENT <br />01100 1 O O PERMIT ##>F### ###ri# i# 6~5 #+~`i$-f 9.O MC E/ RbH <br />~, r P rTr I) REQUIREMENT X ON <br />`.ID.1, TOTAL SAMPLE #:#ri`v i#i,'`-i# iii-~i#%~ ,r-.##v# <br /> <br />iPE'IDED IAEA$UREMENT <br />'053 1 J O PERMIT ###### #i#### `## ####::# ####YY REPORT NCE/ RA9 <br />r FY'm F, REQUIREMENT 'k#"'Y <br />OLIDS <br />SEf.L°18LE SAMPLE #i.r,## #.#ri3 ##### #i.-rd# <br />, MEASUREMENT <br />OSUj 1 O O PERMIT #~#### ###'v#,~ 'Y## ##,"ti,'ri'i ###### O.S aCE/ RAB <br />c ~ REQUIREMENT ##" <br />IL ntiD t: !t~ASL $AIAPLE ,'Irisi## +-TVVV~ vrvii# iv##=`i <br /> MEASUREMENT <br />TE:ON E%TR-G:IAY 1'F <br />TF <br />' <br />. <br />r <br />v'JSSG 1 0 0 PERMIT ###i## ,r.rr,ri# ii>:r Y##### .:##### 10 21CE/ RAB <br />C Or X REQUIREMENT isA ~r <br />IR~t;, TOTAL SAMPLE ###### ##ii## ##r.#i i#~r,# <br /> <br />(AS Fc <br />) MEASUREMENT <br />. <br />G1:;45 1 0 O PERMIT ###### ##iir# ,.~ ##;:#i# ###### REPORT NCE/ RAB <br /> REQUIREMENT <br />OY r w <br />os, It. co~tDULr oR SAMPLE NO DISCHA GE -Y-'°#c ,..r,.iv:x #i;-:=i# <br />tO TH°T i YZNT PLA"1 ~: ME45UREIAENT <br /> <br />SOJSJ 1 J O REPO R2 REPORT ###### #?#### iYiYiY rv EERLY NSTAR <br /> REQUREMENT <br />v ~. <br />TOTAL <br />SOLID:; SAIAPLE -rr.-.:# #i.,-~-. '~:'sY...r :~#:t# <br />, MEASUREMENT <br />nI_ soLV::D <br /> <br />70275 1 v O PERMIT ###### t##### .i ####ii ###### REPORT TSLY RAS <br /> REQUIREMENT y <br />,l, <br /> <br />r <br />1 F• <br />T <br />IJA r.1 El11T LE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE P <br />AND AM FAMILIAR WITH THE INFORMATION SUBMITT ERSONALLY EXAMINED <br />ED HEREIN <br />AND BASED TELEPHONE DATE <br />Arian P. Dunfee . <br />ON MY INQUIRY OF THOSE INDIVIDUALS IMIAEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION I BELIEVE THE $UBMIiiEp INFORMATION I <br />er <br />Mana IS TRUE. ACCURATE ANO COMPLETE. I AM AWARE THAT THERE ARE SIG <br />EN <br />ES FOR <br />T <br />FA <br />M <br />T ,. , <br />g ALTI <br />A <br />NIF (CANT P <br />SUBMIT <br />ING <br />LSE INFOR <br />ION, INCLUDING `D2 774-5253 JD D7 25 <br />Env i ronmenta i Studies THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE IB U SC 6 1001 AND <br />1 1719 /Prnahln undo rhnr Hamm mor mrludr Pore u <br />S <br />C <br />to JIO <br />OW <br />JJ U SIGNATURE OF PRINCIPAL E% UTIVE <br /> . <br />. <br />p <br />. <br />. <br />m <br />l <br />y <br />v OFFICER OR AUTRORIZED AGENT A <br />TrPED OR PRUJTEp rndo.mo.~mam <br />onmrm o/wr+rc,emonr <br />ond f <br />ro~l <br />mla ~Qp HUMBER YEAR Mo DAr <br />P <br />J <br />COr•1IAENT AND E%PLArJA I lUU ur Ar+r vwLA I wrvs lRr/rrrnrr mr arrarnmenrs nere/ <br />iF y0 UiSCdi9;.°. OCCUkS 9F.PORT °NO DISCflARGi:". OIL AND G3EASF.p SEE FOOTNOTd F/. <br />FDrm 392D~1 (ReV. 9~~) P(BY/DUS ed111005 maybe USBd. (REPLACES EPA FORM T-e9 WHICH MAY NOT BE USED.1 <br />PACE OF <br />00502/1COS79-17TIq 7. ~ <br />