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PERMITTEE NAME/'--RESS(rndudr FwlGty Na.v/Locatbn ifD$irent) <br />NAME ! <br />ADDRESS C A R ;i Lj ;: J' f 'I T I D ,'i !" r (i <br />27f3 ;iFikYI?A' CKI'.'f? <br />FACILITY A r; i Y J a w r::i f i� s Y T .'+ • <br />LOCATION <br />Y ti <br />1,TTN: t4i'�•rT. PA'i1 ,YY_ Pit TDF r17' <br />NATIONAL POLLUTANT -)ISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHAR ONITORING REPORT /DMR) <br />(2-1 117-19) <br />.. 1 ., r n r)7 I-,! <br />PERMIT NUMBER I DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEARMO DAY YEAR MO DAY <br />FROM '901 <br />0 n1 III TO ,10; 631 :1 <br />120-21) 122-23) (24-25) 126-27) (28-29) 130 311 <br />Form Ap--oved. <br />OMB I ,40-0004„ , <br />Appro pires,05-31-98 <br />�.i T 'i (1', <br />NOTE: Read instructions before completing this form. <br />PARAMETER <br />132-37) <br />(3 Card Only) QUANTITY OR LOADING <br />(46-53) (54-61 <br />(4 Card Only) QUANTITY OR CONCENTRATION <br />(38-45) 146-53 (54-611 <br />NO. <br />EX <br />162-631 <br />FREOUENCY <br />OF <br />ANALYSIS <br />(64-68) <br />SAMPLE <br />TYPE <br />(69-70) <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMU M <br />AVERAGE <br />MAXIMUM <br />UNITS <br />1 i. A ii :; :: L fi c c <br />i 1 .;J A L <br />SAMPLE <br />MEASUREMENT <br />;_ ,t :t C. <br />Z G y <br />s • :c . - 3;. <br />: , _•..: <br />A 4 U f) 6 1 U J <br />11 1. is " i (f 1 r, r R T, II s <br />PERMIT <br />REQUIREMENT <br />r,, `.r ;x Sx Cts <br />ii � (? i) � T '{ <br />1 +• « <br />}.. = 1 <br />e ( <br />t 1:= .� : , •r <br />y; ., �;: e c <br />;•:, - , .. <br />:,; <br />+. I; �r <br />; <br />SAMPLE <br />/ <br />-------- <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />i <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />t• <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />(, <br />PERMIT'�i <br />REQUIREMENT <br />li <br />SAMPLE <br />MEASUREMENT <br />PERMIT' <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT ' <br />REQUIREMENT <br />NAME/TITLE 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 <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND 33 <br />U.S.C. 1 1318. (Psna/tlss under dwso sbtutss may kwkds rmses up to $ 10,000 <br />+Z... rine knpisovmentofbstwssn6mondAsand 5yew&) <br />ti ! <br />/ <br />f �. i,.• ; <br />TELEPHONE <br />DATE <br />a <. +: f. /" ' •� >"� i.r ! <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />%.ummmY 1 . AIV V rAm^riA 1 wN ur• AIV T V IVLA I WrIC4 1rlererence air arracnmenrs neral <br />-:jLTtLEA!3LE SDLTI'S LI�7zT APP LIE-,!; O'S LY TF C= 1U—T:1, 24—IiR PP1.::IP I,'V I I i C L A 1 11:1, T <br />i <br />TSi E IfiJ'i L11'!I:S WILL P:D: u�: ar`1'f.Ir.'� :D RE P(JRTr",G '1Eri5E;.ti�:.rtilti�--r <br />EPA Form 33 0=1 108=95) Previous'editiona'may bb used. '' (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />