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PERMIiTEE NAME/A~55 R+d,4 Frd,ryN~l.«.rrm dOx?ea)
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<br />ADDRESS ,_ (; L V n I,r ^' j +, ~'
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<br />FACILITY _
<br />LOCATION - ~ (.. L'~r
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<br />NATIONAL POLLUTANT NAROE EUMINATON BYBTEM INPDES)
<br />DtSCHARG {YOKING REPORT DMRI
<br />11-16 I7-191
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<br />PERMIT NUMBER OISCHAAOE NUMBER
<br />MONITORING PERIOD
<br />VEAR MO DAY YEAR MO DAY
<br />FROM 95 07 O1 TD _ 9P 09 3n
<br />1161/1 l11-131 !14151 !1617/ I1B-19/ !36311
<br />Form Ap ed.
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<br />l37-371 E% AN'uYNS TYPE
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS e]-e]! l6L68/ (6470)
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY GF uw rHAr I HAVE PERBONAUY ExAMINEO AND t TELEPHONE DATE
<br /> AM FAMILIM WITH THE INF0 11MATION eUBMITTEO HEREIN; AND BASED ON
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<br />_ MY INQUIRY OF TNOSE INOIMOUALS IMMEDIATELY RESPONSIBLE FOP ~
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<br />OSTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATON IS ~
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<br /> TRUE, AOCUMTE AND COMPLETE. I AM AWARE TNAT THERE ARE
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ~
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<br />THE POSSIBILITY OF RNE AND IMP111SONMENT. SEE IB 0.5.C. L 1001 AND ]]
<br />§IONATURE OF PRINCIPAL EXECUTIVE !~ I; •. (, (+i I' ;': I i •' , r ( '
<br /> U.B.C. E 1]te. lANrld.. uw el... m,Rn.. nnr .t,4A.~Ir rwa w b 710,000
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<br />TYPED OR PRINTED Wormumun ip,-,
<br />A4+Inw,r orbnvwnemoneu W6Yrr.1 J OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS lRererence ell sffecnmenls nere/ -
<br />.'.l i].L%t'~Lr. :1rtLt~•S i.I"+T:' t.ui'LTF:3 ONLY IF C= lU=Td,'.II-F!H PRPCTP EYPtIT IS '^.LATHr.n rte (~I,: ~ .. ~ D~yt'n .•y
<br />~~:':•, ,., ., r; f?G.: LT`tT'r` '~i1.1. ;ipT ?F. dPPLII'.i~ 'f0 :'.EP05:T~:[1 NF:A51!fiF.MRNTS--SFe I.!?.l ~, ~t ,: ') ,. Lt , (:.
<br />SPA Form 3320-1 106-951 Previous editions mey be used. /REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 PAGE OF
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