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PERMITTEE NAME/ADDRESS (I I'd 1 r � NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPi lrOEmApplDv[E
<br /> £aeillp' Name/LPearlon IJ dlpennr) � �� ! '.DISCHARGE MONITORING REPORT(DA/R) ' � OMB NO.20WU0M
<br /> —r I (1-16)—� F -4 1'IrVI�L ApPrOVIICXPI 12-31-87
<br /> ADDRESS r_LL r G• : - �—�(: � L 7�_ I 1`11 FiL ULtiJAIt � 4LR C)t_
<br /> PERMIT NUMBER _ oIBCHAaOE NUMBER � C 5' c�•
<br /> 7.
<br /> �Clli� — LL' L_ (��uN_y i MONITORING PERIOD S ; �`�., o lie
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<br /> __L--- I YEAR NO DAY YEAR MO
<br /> LOCATION FROM TO f _ C 3 •�� - _
<br /> r y 1 u � � MOTE:• i mpla
<br /> ..1- -"• � i (70-1 ) (11-13) (Id-IJ) (76 ) (T6-19) (30-3/) NOTE:Read inEln/etlonE belors(iomptsllnp this loan.
<br /> (3 Card OMy) QUANTITY jOR LOADING (d Card Only)+ QUALITY OR CONCENTRATION = _
<br /> (3e FJ - (46-53). t 3 NO. FREQUENCY SAMPLE
<br /> PARAMETER (d6-53) (N-61 ) (JI-0/) - EX OF TYPE
<br /> •NALYSIS
<br /> r (31d1)I AVERAGE MAXIMUM UNITS MINIMUM AVERAGE• ' MAXIMUM j.L UNITS -
<br /> y 61fi31 '(6afi6) '(69-70)
<br /> SAMPLE F*S I1.9 R 4 V*4 4 4 ,;M Q d i{#f r O a,
<br /> MEASUREMENT
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<br /> r � MEASUREMENT
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<br /> MEASUREMENT
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<br /> MEASUREMENT e -
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br /> S� •Y 1 B*', k ' Y:
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<br /> NAM[/TITLE PR AQP L EXECUT14E OFFICER I cENTIFY uMOER PENALTr doF LAw Nei I°HAVE«PERSONALLY EXAMINED i s.: «' TELEPHONE - DATE «
<br /> AND AM FAMILIAR WITH THE INFORMA ION SUBMITTED HEREIN: AND BASED P„ Y:- I '-
<br /> Y;:// p1 MY INQUIRY OF THOSE INDIVIDU LS IMMEDIATELY RESPONSIBLE FOR C y `I \p ,x L � ` __
<br /> (/ ( OerAINIHO THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION - -4
<br /> r / IS TRUE ACCURATE AND COMPLETE 11 AM AWARE THAT THERE ARE S*
<br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING .., ` A .. -
<br /> !/��� THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE IB USC 11OOI AND /�
<br /> 33 uSC 1 U1B ( \ GNATURE OF-PgINCIPAC,EI[CUTIYf• U. �' ��112 a
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<br /> EPA Form 3320.1'(ReY. 10.79)PREVIOUS EDITION TO BE USED (RRLACp [►A FORM -SO WHICH MAY NOT BE USED.) AGE OF
<br /> UNTIL SUPPLY IS EXHAUSTED 1 013U41/t,;ujr7-49cU i
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