2016-05-03_REPORT - M2013052

• Permit No: M2013052
• IBM Index Class Name: Report
• Doc Date: 5/3/2016
• From: Jean Marie Cowman
• To: DRMS
• Annual Report Year: 2016
• Email Name: TC1
• Media Type: D
• Archive: No

PERMITTEE NAME/ADDRESS(Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPOES)
Facility Name/Location ifdifferent) DISCHARGE MONITORING REPORT (DMR)
NAME .\ERN1 00(.I.)IVIA1 (2-16) (17-19) Form Approved.
ADDRESS lohS Iucepi (dD Alit i# I COG- COR 3`ti"f-- C Minor OMB No.2040-0004
Id..)0 cr,L.A--A/ 4-'ARK CO `s053b3 PERIIIIT NUMBER DISCHARGE NUMBER Approval expires 10-31-94
F-Final
FACILITY /94 ni,,1 S DE( Li:DE C LAM MONITORING PERIOD
LOCATION GMiw . EL. 1>A-5c CDU JT-`r) YEAR MO DAY YEAR MO DAY NO DISCHARGE I
ATTENTION FROM Of 5� C_4- C I TO 2 0I y CC( 30
(20-21) (22-23) (24-25) (26-27) (28-29) (30-31) NOTE: Read Instructlons before completing this form.
FREQUENCY
PARAMETER (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO. OF SAMPLE
(32-37) (46-53) (54-61) (38-45) (46-53) (54-61) EX ANALYSIS TYPE
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (1243) (64-68) (69-70)
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT ****** ****** ****** At -wo)cE5 -1-4CE4/
r
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ****** _
SAMPLE ****** ****** **#*** ****** ******
MEASUREMENT ****** ****** ****t* ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ****** ****** ******
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT ****** ****** ****** ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** _ ****** ****** ****** .
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT ****** ****s* ****** ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ****** ......
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT ****** ****** ****** ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ****** ****** ******
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT i ****** ****** ****** ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ****** ,,,...
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT ****** ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** _ ****** _ *****_* ******
NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED ON MY
.y. { INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
��i�I�+r Lp� � f I.��L���� THE CCU-
RATE ANDRMATION.I COMPLETE.I AME AWARETHE SUBMITTED INFORMATION IS THAT THERE ARE SIGNIF'ICANTrnEUE,LTTIES (/� t;(;'}'N,y�_
FOR SUBMITTING FALSE INFORMATION,INCLUDING THE POSSIBIUTY OF FINE -7/(' 3//—Y5'1/4— �(c / C
)
AND IMPRISONMENT. SEE 18 U.S.C.g 1001 AND 33 U.S.C.g 1319.
TYPED OR PRINTED (Penatees under these statures may include tines up to S10,000 and or madmum SIGNATURE OF PRINCIPAL EXECUTIVE AREA
impnsonmenr of between 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIO bilS(Reference ail attachments here)
Sitr Fen/t: /N>T1a-tp --x e/VSOCE` A/6) s7zRrhlti>`3-1 ' Rc/IAte Ff.- j ctrl 77//S .s ire- 5Ee ,-r.'ccsd 7 --
EPA
--EPA FORM 33261(REV.LA)Pnvlou*editions maybe used 00005/950315-1633 PAGE 2 OF 2
(REPLACES EPA FORM T-40 WHICH MAY NOT SE USED)