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. PERMITTEE NAME/ADDREBS (Include" N ATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) pDrmAppD9ed
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<br /> vIvPlSeT1111w1/V df 1 DISCHARGE MONITORING REPORT 1 OMB No.2O10.M
<br /> 2-16) 17-19) A
<br /> ADDRESS I��'LC=rLLi'.L— ��- - - �E09Et W"•`"'�2'31•'�J
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<br /> PERMIT NUMBER19 CIeC NwgOE NUMS[R 1 c T
<br /> ACILI Y I LJ�O f' ' u MONITORING _PERIOD y v I ;, = .I
<br /> —L--------- — /• ,L� YEAR MO DAY TEAR MO- DAY, I > > N L
<br /> LOCATION __ I I I F� M If Vr 'U J i TOI`lr•`i, :' " C m - L. I1_
<br /> -.rr- I (20-21) ( 2.23) (24-a) (26 ) (26-29) (3B-3ry NOTE:Read Instractlons before completing this form.
<br /> 1 (3 Card Only) OUANTITYIOR LOADING (1 Card Only), QUALITY OR CONCENTRATION
<br /> PARAMETER (46-53) Q4-61) (3845) (I6,JJ) (Jlfil) NO, F. EOOUFNCY SAMPLE
<br /> ` EX TYPE
<br /> (32 ANALYSIS
<br /> 37) I AVERAGE MAXIMUM UNITS MINIMUM •AVERAGE. MAXIMUM 1, r UNITS 62.63) (61fi6) (69J0)
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<br /> :(�ERMLE
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<br /> NAME/TITLE PRIPICIPAL,EXECUTJVE OFFICER I CERTIFY UNDERO ICNALTY OF LAW THAT I HAVE PERSONALLY EXAMINED Y,a' r �. - TELEPHONE' I.
<br /> D A T
<br /> I.NO wM FAMILIAq WITN THE INFORMATION SUBMITTED HEREIN AND BASED = ` y21 y,� ]; _
<br /> ��✓ / �� ON MY INOUIRr OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR -4 OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION - i• I •� I :�� ' - _- '
<br /> IS TRUE. ACCURATE AND COMPLETE n AM AWARE THAT THERE ARE SIG - y r L -7 _ � _1l
<br /> A^ NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING �/]y .l ��••
<br /> e7,. /..• O f S(// 'V, r., THE PO'BIBILIir OF FIN[ AND IMPRISONMENT SE[ IB USC 1 IOpI AND' �1GNATUIIE OF.-P.AINCIPAI EXECUTIVE -V I r� 222 V lU
<br /> 33USC 11319 IPmalau undo them, ImruNr ma mrhdr /mrn up lu lIaJFYI
<br /> V TYPED OR PRINTED I and...manmum mlpn...m.urn/A.,u..nlmnnM.and S� .•raI i'OFFICER-OR'AUTHORIZEn AGENY..- 'HUMMER YEAR MO DAY
<br /> COMMENT AND EXPLANATION OF ANYI VIOLATIONS (R.lerence all u.chanent, her.) 1 G ,y. `j,`
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<br /> EPA Form 3320.1 (F3ev. 10.79)uRREVI SUS EDITION PPLY IS TO BET USED (RVLACO EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br /> NTIL . Ul:V6a/LI'34�u7—L9e:C
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