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PERMITTEE NAME/ADDRESS (Ineludf j NATIONAL POLLUTANT DISCNAVIGE ELIMINATION SYSTEM (NPDF.S) F0(10AppG9ed
<br /> f9rrllp Name/Lomrlon I/d/Ornnl). 77 /4rxtn n-1 DISCHARGE MONITORING REPORT(DAIR) O�No.2D*M
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<br /> _—Q'—G'Zf"L "fi'C�L'VY'S r _ x i c
<br /> MONITORING PERIOD L _ w c 'cy i ;
<br /> FAgi- —1—L�LL--_—_— 1 YEAR MO DAY YEAR MO.' DAY- n r j _ _ y T p
<br /> LOCATION _—Ll 1 JCL --_— --_ FROM L'i 1 G (. 1 TO 3 'f h1 ri r�I K c ; = yU:1 L_
<br /> ) NOTE: Reed Instructions 6elore DO Ielln this lorm.
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<br /> 1 I (! Card Only) QUANTITY,OR LOADING (I Card Only)_ QUALITY OR CONCENTRATION j :_
<br /> PARAMETER (16J3) (SYfiI) (A9-I!J , (4e-33) � � (SId1) = C _ � fE%, FREOOUF Hcv BTYPE!
<br /> - ANALYSIp
<br /> (17-37J AVERAGE MAXIMUM UNITS MINIMUM 'AVERAGE'• MAXIMUM =m, UNITSy 61�71 .(y)�8) (69-lO)
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<br /> vR�QUREMET&"
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<br /> MEASUREMENT
<br /> MEASUREMENT I C
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<br /> MEASUREMENT - m z '� n - I `+u M ` ❑ -,r
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<br /> SAMPLl1I IX f•41FP- 4PMa �%w.in \� :i 1T -.0 +.
<br /> 4 MEASUREMENT I = N Y= i' �L - V v
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<br /> 1 ' SAMPLE 44 i-L* 4* t/ W.
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<br /> MEASUREMENT
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<br /> MEASUREMENT 1 �- W x? �• 1 L�L'J' a
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<br /> NAM[/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFr UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED :L Y'r� .+� 'TELlPNONl� - D A T !
<br /> ANO AN FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND
<br /> BASED r_
<br /> 1 ,/ ON MY INOUIRY OF THOSE INDVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br /> `"LJ�T//(I/ OBTAINING THE INFORMATION. I eEWEVE THE SUBMITTED INFORMATION
<br /> IS TRUE. ACCURATE AND COMPLETE •I AM AWARE THAT THERE ARE SG -
<br /> NIFICANT PENALTIES FOR SUBMRTING FALSE INFORMATION INCLUDING
<br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE IB USC 1 1001 AND J , � ;7 l
<br /> r; %�11•P-iDLt� [[[/// �- / ir 33USC 11319 IPrneUirr uMr. rbw Iramrn nm mrludr pnr, up rn JI0.Mn BI NATURE OF PRINCIdAL E%ECUI E
<br /> TYI+ED OR I'R INTED .IW Ilem.T.mum.mpnn.lnrrrlr n/MruY.nBmnnrA.FnA.S>nM.I OFFICER OR AUTNORI2ED AGlNT�'� �NUMSER YEAR MO DAY
<br /> CODE
<br /> COMMENT AND EXPLANATION OF ANY,VIOLATIONS (Refer,.,,all uuuchmrnh here)
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<br /> EPA Form 3320-I (RSY. 10-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FORM TE40 WHICH MAY NOT BE USED.) GA E OF
<br /> UNTIL SUPPLY 19 EXHAUSTED UC'A I! I/I.V v:#0 I-L JZ tT 1
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