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(NPDES)
Facility Name/Location if different) DISCHARGE MONITORING REPORT (DMR)
NAME .]t✓AKl ar ul, (2-16) (17-19) Form Approved.
ADDRESS labs ,,Cl )D AidE" 4/ COG-01(i 3A112() Minor OMB No.2040-0004
LA 1nerI AAA ?ritC'K C'G gL134:23 - PEKOE NUMBER DISCHARGE NUMBER Approval expires 1041-94
F-Final
FACILITY Ac,Nt1S bel Labe (LL4-,4'\ MONITORING PERIOD
LOCATION t,a(IfJ('Ci)vfx- .'D EL ?FSG ."oiIAITle YEAR MO DAY YEAR MO DAY • • NO DISCHARGE
ATTENTION FROM 2U 15 t C I TO )-f)t i 12 31
(20-21) (22-23) (24-25) (26-27) (28-29) (30-31) NOTE: Read instructions 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) (54-81) EX ANALYSIS TYPE
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 112-an (6468) (69-70)
SAMPLE ****** ****** ****** ****** ass***
MEASUREMENT ****** ****** ****8* - IJO .`f..Yii111/ 77/E/C/
PERMIT ****** ****** ****** ****** 30-DAY AVG ***#**
REQUIREMENT ****** ****** *s#*** ,,,,,,,, ...�,,,,_ `
SAMPLE ****** ***#** *##*#* ****** ******
MEASUREMENT ****** ****** ***#** ****** - ******
PERMIT *0*** ****** ***ss* ****** 30-DAY AVG ***#**
REQUIREMENT ****** ****** **##** , ****** _ ******
SAMPLE ****** ****** *****# ****** ******
MEASUREMENT ****** ****** ******
****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ******
REQUIREMENT ****** ****** , ***e** , ****** _ ******
SAMPLE *#***# **8*8* **#*** ****** ******
MEASUREMENT ****#* ****** *#**** ****** ******
PERMIT ****** ****** ****** ****** 30-DAY AVG ***#**
REQUIREMENT ****** #***** #*#**#
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT **s*** ****** ******
****** ******
PERMIT ****** ****** 8***#* ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ***ss* - ****** - **8i#* .
SAMPLE ****** ****** ****** ****** ******
MEASUREMENT ****** ****** ******
PERMIT **8*** ****** ****$* ****** 30-DAY AVG ******
REQUIREMENT ****** ****** ******
SAMPLE #*###* **If*** ****** ****** i.�..,
******
MEASUREMENT
PERMIT ****** 30-DAY AVG **##**
REQUIREMENT ****** ****** _ ****i _ ****** _ *** * _ _
NAMETTITLE 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
�J /�� �,( INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ))
CeLLItt'�m 01 -04ro. THE INFORMATION.I BELIEVE THE SUBMITTED INFORMATION IS TRUE.ACCU- �� i-e6043,1-----
FOR
���M�—
RATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES Y
FOR SUBMITTING FALSE INFORMATION,INCLUDING THE POSSIBILITY OF FINE �/C9 �i - �/s�C)� 2. �O
AND IMPRISONMENT. SEE 18 U.S.C. §
1001 AND 33 U.S.C. 1319. f "1 I
TYPED OR PRINTED (Penalties under these statutes may include fines up to $10,000 and or madmum SIG 7I/RE OF PRINCIPAL EXECUTIVE AREA
imprisonment of between 6 months and 5 yeer3.) OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATO HS(Reference a I attachments here)
,2 —i)-- i.(: 11-fr Lit-ST _Dei-", - Ailbt /4:, >tT j7/IS_ Sat: J Tie . E-135KWI SILT -Pe/1[i'E IA/ 144C-E - 4'0
EPA FORM 3329-1(REV.F88)Previous editions may be lewd. 00005/950315-1633�r"lle5 7MKEEN0t/�j,A16- TI((s 14JPl eD. <-1�
(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED) 00005/950315-1633 PAGE 2 OF 2