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PERI?ITTEE NAME/~58 (l,.rYi FrWyNaWloc.nen VOrpew) i'. ~ GL•:. !{ LIB 91u it I FACILITY LOCATION NAME 1. :'~ t ._ I '1' 1, !( :~): C /":. Y L.?. ADDRE88 1a) L'.+ H : 1 '• ? r, :: NATIONK POLLUTN 1cNARGE ELIMINATON srsrEn~ //NPDESI DISCHARI NITORINO REPORT IDMR1 (1-r6 I7-19I 1r'9~II l1 ~ F ! PERMIT NUMBER Dl4GXARGE NUMBER MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM q ~{ 1J U 1 TO 7 R 1? ~~ !1611/ 121-131 /14151 116171 (18-191 !3631/ I Form TA.1• ved. t.%; l; "r; : ~ m . ; 1..; .. . -. r' tO,MB7 1 0004 ,. L. Approv roll"OS-31-98 rG ...~ gi.:) .. .+:1 F' - t• 'I '. r. I. y !" !: , '= i.:Y: df ... _ ~I~a~ u1~.: ~/~ .. .. ... NOTE: r Rasd Inrrtrunlorr befor i~Eompbtlnp thlrr form. PARAMETER {3 qrd only/ QUANTITY OR LOADING N urd onlrl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE /46-531 /54-bEl (39-51 /4653 (5461/ EX ~V (31-371 µ y4 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (s1-ail (64b91 Ib9-701 :,i (. !E :: i~l :i~F: :1. SAMPLE :':I:: r,; r,. .^,: I;: ~ ?q) ~n}:,t r:~n, ,}+};, t+: r: .... y I . ~ 1' 6 1 MEASUREMENT ny,u.: 11 1 i) (; PERMIT -. ~.~ .~,"~r:T,,.rw; r^.. ... -~ ~ `'- ~~~a.rinr,~u;k;; . ~ .:.:.~.:~: ?,I gf{r+.ifr:~~. ~~ .~FY o;; e})~dtVf~~~ .. ~~ 1F•,-~t: i. j'ei 7':11 :.h t~L~l; '. ':' I~:~.)'': ~' '; A I. tI. .REQUIREMENT ~.~ .:.:..: :. ~. ~:+/ r .. ! X'~ Nt7=(, .~ ~. ~ ~:: ~:~ SAMPLE MEASUREMENT ~::PERMIT~ :~ ~~~ ~ ~~~ ~ ~ . ~ ~ REQUIREMENT ~. .~ :. .. .. .:.. ~ . ..: .. .. SAMPLE MEASUREMENT .: PERMIT .. ... .:.. ,. ~ REQUIREMENT ~. ..... ~.. ~.: . .. SAMPLE MEASUREMENT PERMIT ~ ~ .. .. .. ... ~ ~ .. REQUIREMENT .. ... ~ .. ..:.. .~.: . ~: ~ ~ ... . ~ . . SAMPLE MEASUREMENT ~: ~: PERMIT ~. ... ... :~ REQUIREMENT ~ ~ ~~~~~ ~ ~ ~~ SAMPLE MEASUREMENT . . PERMIT ~.. ~:: .' ~ ~ ........ ~ .......... .REQUIREMENT ~ ~~ ~~~ ~~~~ ~ ~ ~~ ~ ~~ SAMPLE MEASUREMENT ..:..PERMIT.:. ~~ ~ .. ~ ... :. .. . ~~ .:.... ~ ....~.~~ . REQUIREMENT ~ ~ ~ ~ ~ ~~ ~~ ~ NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTr of AM FAMIDAR WITH THE INFO uw THAT I HAVE PERSONALLr EXAMINED ANO RMATION SUBMITTED HEAEIN; AND BASED ON j ' TELEPHONE DATE MY INQUIRY OF THOSE INDINDUALB IMMEDIATELY RESPON9BLE FOR ~ OBTNNING THE INFORMATION. I BELEVE THE BUBMITTFD INFORMATION IS '-- -. ~ ~, ~/~y )/-- 'Y+A~ /`-'- i J TRUE. ACCURATE AND COMRETE. I AM AWARE THAT THEAE ME SIGNIRCANT PENALTIES FOR SUBMITTING FALSE INF011MATION INGLUDIMG ~ ~ • / Iv 1 1`- , /~ ~ l ~ / ~ i f ' ~ ~ I I ~~ ` ~ ~I l ,I y i 1~ (i ~ ~- THE POSSIEILITY OF HNE AND IM%USONMENT, SEE 18 U.5.41 1001 MLD 1] BI NATURE OF PRINgPAI EXECUTNE l f I _i ~ ( I V.S.C. 1 1318. fhrWU.. uvr tMr Nlvh. mry ileAM IPr• w ro lIO,OOp Q AREA TYPED OR PRINTED Wu~m..I++nr iryd+w+wnr olbw.An en.onrAA Awbrws.l ~ /OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV COMMENTS AND EXPLANATION OF ANY VIOLATIONS lR~relsnce sA enecnments ne7el .,.':TL'cA."Li. ~nLIi~~ LILT.(' 1.'+F1.7E4 (:r,ILY IF C= 10-Y3, 2U-i+{? 'R~C.iP EYE~T I; CL?.In°L. i c.l,r.,:, ~'1'~i177„ I-. '! (;CU, T5 I% TAU" LIrTT:: aiLL ?701' ' ' ' C nPP1.IED T7 REPOPTF.lI `1FASUR°M?NTS-- !'F' F.D.1.T, !•G a r,vrl' C...'LC, :. ;' {~.. ' E E 3 F i 1r "' " EPA Form 3329.7 108.95) Prevloue edHlonB mey De used. ~ 3 3 (REPLACES EPA FORM TAO WMICN MAY NOT BE USED.1 0 o e 3 ~ / ~ ~ G ~ t i _ I ! i ~, PAGE OF