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PERMITTEE NAME /ADDRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />Facility Namekocationifdifferent) DISCHARGE MONITORING REPORT (DMR) <br />NAMES 1'� +• 5 it \ t!, I�1G \11' �C (2 -16) (17 -19) <br />ADDRESS , -- <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY r -> MONITORING PERIOD <br />LOCATION \� <� V� klyv: ��; �L .cr. �� �� „` ('�; >\' Ily "� YEAR MID DAY YEAR MO DAY <br />ATTENTION( ,� �} ,.�,�r',i �f T��� FROM I ? TO <br />(20 -21) (22 -2F) X24 -25) 26-27) (28 -29) (30.31) <br />Form Approved. <br />Minor OMB No. 2040 -0004 <br />Approval expires 10 -31 -94 <br />F - Final <br />NO DISCHARGI <br />NOTE: Read Instructions before completing this form <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />1 <br />SCIm(pIE, WCtS-lc,: ^r� x��c, ik`�S (l,Cls'iir lyN ,n�x,r'I \' LCC. SL, rye WeiE 'ICJ --& <br />' IY U fA <br />EPA FORM 3320 -1 (REV. 9.88) Previous editions may be used. <br />(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED) <br />000051950315-1633 <br />PAGE 2 OI <br />FREQUENCY <br />PARAMETER <br />(3 Card Only) QUANTITY OR LOADING <br />(4 Card Only) QUALITY OR CONCENTRATION <br />NO. <br />OF <br />SAMPI, <br />(32 -37) <br />(46 -53) (54 -61) <br />(38 -45) (46 -53) (54 -61) <br />EX <br />ANALYSIS <br />TYPE <br />(62 -63) <br />(64 -68) <br />(69 -70 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />} <br />SAMPLE <br />_ <br />�w• -L <br />'C <br />`` a <br />MEASUREMENT <br />IY ; <br />C CI ( G <br /># # # ## <br />PERMIT <br /># # # # ## <br /># # #kg# <br /># # # # ## <br />30 -DAY AVG <br /># # # # ## <br />� I qtvt w SS <br />REQUIREMENT <br /># # # # ## <br /># # # # ## <br /># # # ## <br />,� ` (j <br />171dS'I �O� SIISPI'1t1.f'd <br />SAMPLE <br />* # # ## <br /># # # ## <br /># #s # #* <br /># #F <br />(`) <br />'a'�l <br /># # ## <br />? <br />TWiLt,• <br />C3 <br />MEASUREMENT <br />## # #M <br /># # ## * <br /># # # # #x <br />MIJL <br />O ,-mN -ti., <br />PERMIT <br /># # # # # # <br /># # # # # <br />* # # # ## <br />30 -DAY AVG <br />L ^OS�,C I C <br /># # # #x <br />(� <br />REQUIREMENT <br /># # # ## <br /># # # # ## <br /># # # # ## <br />QI af\6 C as(" <br />SAMPLE <br />MEASUREMENT <br /># # # # ## <br /># # #* ## <br />IY�t� r <br />PERMIT <br /># # * # ## <br />* # # * ## <br /># # # # ## <br />30 -DAY AVG <br /># # # # ## <br />c35 � C <br /># * # # ## <br />�llri L <br />REQUIREMENT <br />SAMPLE <br /># # # # ## <br /># ## ## <br /># # # ## <br /># # ## <br /># # # * ## <br />Tw, w <br />V ISQj <br />MEASUREMENT <br />S(-1 Cldc 1 C <br /># # # # ## <br />PERMIT <br /># # # # ## <br />* # # # ## <br /># # # # ## <br />30 -DAY AVG <br />* # ## <br />GF� I F' rt%SS <br />REQUIREMENT <br /># # # # ## <br /># # # # ## <br /># # # ## <br />SAMPLE <br /># # # # ## <br />:* # # # ## <br /># * # # ** <br /># # * # # # <br /># # # ## <br />MEASUREMENT <br />_- <br />PERMIT <br /># # # # # # <br /># # # ## <br /># # # ## <br />30 -DAY AVG <br />k # # # ## <br /># # # ## k <br />REQUIREMENT <br /># # # # ## <br />* # # # ## <br /># * # ## « <br />C <br />SAMPLE <br />G <br />MEASUREMENT <br />- <br /># # ## <br />PERMIT <br /># # # # ## <br /># # # # ## <br /># # # # ## <br />30-DAY AVG <br /># # # # ## <br />Z O <br />REQUIREMENT <br />SAMPLE <br /># # # # ## <br /># # # # ## <br /># # # ## <br /># # # # ## <br /># # # # ## <br />RDCS F� <br />\S \�NpFP <br />MEASUREMENT <br /># # # # ## <br />## « # # ## <br />y <br />PERMIT <br /># <br />30 -DAY AVG <br />* # # # #* <br />DN <br />MN N N <br />REQUIREMENT <br /># # # # ## <br /># ## R ## <br /># ## <br />NAMErrITLE PRINCIPAL EXECUTIVE OFFICER <br />I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY <br />TELEPHONE <br />DATE <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ACCU- <br />_ <br />RATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENAL <br />FOR SUBMITTING FALSE INFORMATION, INCLUDING THE POSSIBILITY OF FINE <br />IV) I c (' <br />AND IMPRISONMENT. SEE 18 U.S.C, 1001 AND 33 U S.0 § 1319 <br />(Penalties under these sta!utes may include fines up to 810,000 and or maximum <br />r J r� p( )Li <br />JiV <br />i7C <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />AREA <br />MO <br />DA <br />TYPED OR PRINTED <br />imprisonment of befween 6 months and 5 years.) <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />1 <br />SCIm(pIE, WCtS-lc,: ^r� x��c, ik`�S (l,Cls'iir lyN ,n�x,r'I \' LCC. SL, rye WeiE 'ICJ --& <br />' IY U fA <br />EPA FORM 3320 -1 (REV. 9.88) Previous editions may be used. <br />(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED) <br />000051950315-1633 <br />PAGE 2 OI <br />