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<br />ERMRTEE NAME/AD~ 1lnr•ludt <br />riliry Neme/L ocnion 1! JlemnTl <br />4ME_~r.~.t...r .L ~~+t~:11a~~iY ~~A-...IL ~~~ __ <br />DDRESSt ~lt~ I1'l lt"4 ~p f.e ___________ <br />--~5~:: ter __--__-Jl.~?(i0-21-_ <br />4CILITY- ---------------.-- <br />~__ ____ <br />JCATION KJ ` Uc~l`~ Gcc V ~ ------- <br />-_---- <br />NATIONAL POLLUTANT OIeC E ELIMINATION BYlTEM (NPDES I <br />DISCHARGE MON ORING REPORT (OMRI <br />!?-161 /I7-/91 <br />~ri~: ^n ~ ,.. <br />PERMIT NUM6ER ouc HAwoc Nv.ecw <br />MONITORING PERIOD <br />YEAR MO DAY TEAR MO DAY <br />FROM ,~ _ TO <br />raan rz-+u 114~_TI r/e~_nl is-al rJaan <br /> <br />~.;7~ <br />~ ~ r a a ~, ~ ~ rwrgf~lppoved. <br />. - I ~~ T ,. c T ..OMB No. 2040.0004 <br />^ ~ ~ 7 N7 ^ {I ^ -APPr4ral,e{cPlns ~(1'~)'Bg ~ R <br />NOTE: Read instructions before completing this form. <br /> ' (J Card Only) QUANTITY OR LOADING (4 Cab Only) QUALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(46 ~SJ) (y4-61) <br />1J8-4S1 (46-S.TI !SJ-el) <br />NO. <br />E% FREOUENCr <br />~ <br />SAMPLE <br />TTPE <br />!J?-J71 ANUrss <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> Id:dJl l6ad81 Id Glur <br />~:.I~I^°e SAMPLE ~..~.-iX:: ~.'v.-~'i`~ \\ (~ <br />I J ,nom. r..- v..... I _ <br />` ,^~ <br />U <br />^ <br />IT <br />' MEASUREMENT J <br />V Q f~ <br />. ~HR0;7I <br />_ <br />tI?^!iaL <br />L - <br />I~~il _ 7 ~ PERMIT rG4x4$ r~'.r`r'.=r .r. [t !?POUT ~.`-vC4`v i``~!:'Y`.'k .t %t'1"C TRI.T 0!!P05 <br />^.;"ri r, !I ~, ,. .Z~ T J~ REQUIREMENT •,Y 0 n^ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASVREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMR <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMR <br /> REQUTAEMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> 9AMPLE <br /> MEASUREMENT <br /> PERMR <br /> REQUIREMENT ' <br />AME/TITLE PRINCIPAL E%EGUTIVE OFFICER I CERTFY UNDER PENALTY OF LAw THAT I HAVE PERSOrvALLV Ex AMirvED TELEPHONE D A T E <br />~~ AND AM FAMIIAR WITH TlE INFORMATON SUBMITTED HEREW. AND BASED <br /> CN MY MgIARY CF THOSE NDVDUALS MMEDMTELV RESNNEIBLE FOR <br />_\~~A,A.~ mVL•05 OBTMyNG THE TIFQtIMTUI 1 ffLIEVE THE Sl1EVAITTED MFORMATIOH IS "'l <br />G <br /> TRUE ACCWATE MO COMPLETE 1 AM AWARE TINT TIERE ARE <br />SIGreFIGNT PENALTES FOR SUBMITTING fALSE INFORMATION INCLUDING <br /> <br />l <br />THE PpBSIBLITV CF FNE AND MPRSONMENT BEE IB USC / 1001 AND / -/' <br />76 ] <br />J <br />33 uSC 1 131G /iknchka order Iheu mmrca m <br />nclude !'nea u <br />ro SIGNATURE OF P CIPAL EXECUTIVE .7 <br /> <br />TYPED O PRINTED q <br />p <br />. <br />SIOOW cnd w nMaimu,:. imglMmnl011 W eelween 6 monrhr And J )TArxl <br />OFFICER OR THORIiED AGENT AREA <br />NUM°ER <br />TEAR <br />MO <br />DAY <br />)MMENT AND E%PLANATION OF ANY VIOLATIONS /Re(eR`nre Ill rtRChminla Atn:) <br />~F PART I. R.4 FOR T35t PHO~. RPi RESULTS OP LEtRALIYi DEi7IVAtNS AS °~SPPRC?°,GRJFT3: NEPR7n DP.RT.VA*95 AS <br />[OIICI!'Y°. RPT LOp°ST:ePPL Af N9I'H STpiI':TI('ALLT 3IGNIP DZFP :?V °F~T':C~NTRDL iIF.: "19:,!'.RY°.D USI'7, ?~'* <br />A nrm .'+77 •1 lOnv Q- 1 Pmviro rc n ilinn.c m3, n .,ten 'rprel ~~ Fen ~ ••`^ •n.+o _.. .. _ _. .. ~~ <br />