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PERMITTEE NAMEIADDRESS(Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES) <br /> Facility Name/Location ifdtfferent) DISCHARGE MONITORING REPORT (DMR) <br /> NAME OrAA!� Wct\Jt (2-16) (17-19) Form Approved. <br /> ADDRESS 1l)bS- a, LtieaaCAikID It I COG- ((''CrR 3" 7X % Minor OMB No.2040-0004 <br /> 41,1 r"Nis-MD pA(k I co �'a ti 3 PERMIT NUMBER DISCHARGE NUMBER Approval expires 10-31-94 <br /> F-Final <br /> FACILITY AL tJUS IX 1 LC`}D f c(AIM MONITORING PERIOD <br /> LOCATION 4KI u\ , E L PRS(` ec^DA&)Tyt YEAR MO DAY YEAR MO DAY NO DISCHARGE <br /> ATTENTION FROM ,9 ri 1 S ()ci C‘ TO p i t p( 3C) <br /> (20-21) (22-23) (24-25) (26-27) (28-29) (30-31) NOTE: Read k et,uctlons before completing this form. <br /> FREQUENCY <br /> PARAMETER (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO- of SAMPLE <br /> (32-37) (46-53) (54-61) (38-45) (46-53) (54-81) EU ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 112411 (64-68) (69-70) <br /> SAMPLE sssss* #****# sssss* ***s#s sssss* <br /> MEASUREMENT sssss* **s*** ss#ss* , A,(, `� FL S -74 /(,� <br /> PERMIT st**** s****s ss#ss# sssss* 30-DAY AVG s***** <br /> REQUIREMENT ****** ****** **ft** <br /> SAMPLE sssss* *****s **so* sssss* sssss* <br /> MEASUREMENT sssss* ss**** sssss* sssss* **#*** <br /> PERMIT sssss* s**#** #s**** sssss* 30-DAY AVG sssss* <br /> REQUIREMENT s***** ****ss ***s*s t*****_ sssss* <br /> SAMPLE sssss* sssss* #s*s*# ****** *****s <br /> MEASUREMENT sssss* sssss* **ss** sssss* sssss* <br /> PERMIT sssss* sssss# ss***s **s**# 30-DAY AVG sssss* <br /> REQUIREMENT sssss* *s**** *S**** , **kiss _ **It*** l <br /> SAMPLE sssss* sssss* **to* sssss* sssss* <br /> MEASUREMENT sssss* sssss* **us* sssss* sssss* <br /> PERMIT sssss* sssss* s***ss **s**s 30-DAY AVG sssss* <br /> REQUIREMENT sssss* **,t*** **sus <br /> SAMPLE sssss* sssss* **ins ****** sssss* <br /> MEASUREMENT *sssss ****** ****** ****** sssss* <br /> PERMIT s***** **s*** *ss*s* sssss* 30-DAY AVG ' *s**** <br /> REQUIREMENT **s*** ****** , sssss* ****** *****s <br /> SAMPLE ****** *s**** **##s* ***ss* ****** <br /> MEASUREMENT **s*** ****s* *ss**s ****** 4 ****** , <br /> - <br /> PERMIT sssss* sssss* **ss** sssss* 30-DAY AVG sssss* <br /> REQUIREMENT s***s* _ ***le** *OM , may,,,,., <br /> SAMPLE ****** ****** <br /> SAMPLE ****** ****** *ism <br /> MEASUREMENT ****** ****** sss*s* *,... <br /> PERMIT sssss* sssss* **ss** sssss* 30-DAY AVG sssss* <br /> REQUIREMENT *s**** _ ***s** _ *s**** _ — **s*** *** - — <br /> NAMERITLE PRINCIPAL.EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING 71. <br /> �y �1 THE INFORMATION,I BELIEVE THE SUBMITTED INFORMATION IS TRUE,ACCU- <br /> E1 1 `C�CL Yb A A (�l V C '\�l �' RATE AND COMPLETE. I AM AWARE THAT ARE SIGNIFICANT <br /> \ FOR SUBMITTING FALSE INFORMATION,IN HCLUD ITNG THE POSSIBILITY OFLTIES FINE C/4-11.1/}1i/<11- <br /> AND IMPRISONMENT. SEE 18 U.S.C.§1001 AND 33 U.S.C.§1319. 'q -pi'b y 7c aO t r C!, 0 <br /> TYPED OR PRINTED Imprisonment <br /> under these statutes may include Ores up to 510,000 and or maximum TURE OF PRINCIPAL EXECUTIVE AREA <br /> Imprisonment of tetneen 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY , -+—^"--tHNe <br /> Pur T JIMLY viot J t THE A; /jeA-071 .i4brf) 11r&'i,Ltr (s'HAi h) TO) ,k/C MMMM- F fT riS SiTUAU4_ ?JAII 20Is Slc.7 F A!CC <br /> EPA FORM 3329-1(REV.5-68)Pesvioua editions maybe wad. !REPLACES EPA FORM T�0 WHICH MAY NOT BE USED) 00005/9503154633 PAGE 2 OP 2 <br /> 661kS /4;571/LID 1C EA//Rt" Alt RMu re-k R1IA4 FF R n 76,/465' 4T res SITE. Set b71tLe . <RC— <br />