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PERMITTEE NAME/ADDRESS I /nclude <br />F~rlllty Name Lcenlpn If dllYe,enU - <br />NAME STetit~'u:u.-i-~L~Ai2.-LL11~__ <br />ADDRESaNEM HOR~(101_~NF`-__-______ <br />---p'°-=fir SL------- <br />- - - - - - <br />--_NUC (I---------- C~Ov~24-- <br />FACILJTY <br />LOCATON <br />A'"T:2: ft. LAIC! HADE, :'IS£ f!ANAGEk --- <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SY6TEM (IVPOFS) <br />DISCHARGE MONITORING REPORT (DMR) <br />(1-I6) (17-19) <br />:-n000U213 OU3 A <br />PERMIT NUMBER onrxwwoe xuxeew <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ I TO <br />(1611) (J1-17) (14-15) (16-17) (18-19) (JO-ll) <br />:lINOR <br />(5 U U R W C) 54SVR1-Pl~v~. <br />F- f I V A L OMB No. 2040-0004 <br />O N D R U K O f F~R`Shfs~!'BT~Pf17E"~ R A W <br />'^:z°' NO )' SCHAitGE ~ v'ki` <br />NOTE: Read Inetructlons before eompletlng thls form. <br />' (J GM Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATK)N <br />~ <br />FAEOIIEtaCY ' <br />SAMPLE <br />PARAMETER (46-5J) (5461) (38-45) (46-SJ) (5461) ' <br />E% GF <br />ANALY55 , <br />TYPE <br />(3137) - <br /> AVERAGE MA %IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (1?4J1 (616!1 ^_ (4--70) <br />~ SAMPLE :,•. Y,I L:#-'.~!' #:: s.h Kl %'S .',t'J~OC: s3 ( 12) - - I <br /> MEASUREMENT ~ <br />)U~10') 1 G 0 _-e~ERMIt - ~klRs?171Ei~s- . .__I~'ALft?sY0 .'- :ir:;• b.. `s __.. _. Cr40>Vt10Di ,- -51.IQ'=.-.,._; .... <br />'}'FLUEN'T Gf2J55 YALUE REQUOr~liet4T '~'' <br />, t!ZfilMUfi ll~~I7}t3lS"'' SU y <br />4 <br />OLIDS, SETT LEA F!LE SAMPLE ''s K"t'y'''O'~ 4#O#O'k ( ~ 5) _ 1 <br /> <br />MEASUREMENT <br />- <br />_ . <br />USuS 1 i) U ~;,,,, a~xeoaa ~•'aac<nlla :1~:= OPTIONAL ftEYQ&X . 0: ~ <br />L'F'fLUENT G;2GSS VALUE ~auutoaENT r.:=.°° P.TR AVG 30-A.?AQG - ' LYL M% HL/L <br />FLOIi, L;i C0IIDUIT ~l i! SAMPLE ~ v3) f,::kK::i :4~: >3O#~i?::s 4#bC## _ <br />f :1 k U T ii E n T Y? ti T P L 4 ii 'T MEASUREMENT <br />l OG ~ 0 1 . U . it PERMIT' REPORT RPP03T . tiYaaa## clva~aa>,rs. 9fQ0 >D ,c#o ~ ; <br />'FFLUENT GRO5S YALUE ~nul~Er4T -3p-A 1ttIG -AILY MX :; CI <br />" :; '%'k'~# : <br />I <br /> . <br />. y <br />: <br />~OLZDS, TGTAL SAMPLE ':::;#i:~: (: t;:r,:v17C ~#r,.Y::=: ( 19) =~ <br />Z ~ 5OL V E [/ MEASUREMENT I <br />Ut9; 1 U Q ~,;,;~ #;:+aaar,, *k'>ti~A,Y%ftf r.:::s fsa#sk#:1 ABPORT -, 'QP~1,~~iL °' <br />EFr'LUE9T GjOSS V9LUF. REQUU~EMEr4r ,::::;:". R•Cff AY,G R4'')t'°NAY MC/L "i -~'" <br />u <br />:IL A!IG (: f.;,':;SE SAMPLe C'vL:nK::: ( vu) a::taa::::: :'tb##t~:t a#aoa:A I• <br />L S U A L MEASUREMENT ' <br />3uU65 1 U G r <br />R s¢aataa p g;.l L'sCs:FC#'~ a~laellTa' IplypMplly 7#Ti ~ y: <br /> PE <br />w <br />EFfLU°N'f Gi{iJS:; VALUE REQt+uareMENT ISM? liAL !IO=G sj. ##at, -'~. <br /> SAMPLE ' <br /> MEASUREMENT _ <br /> ~ _ <br />PERMIT - ~ <br />' ,.,- <br />i~'~ <br />. <br /> R6QOIRPTMENi ~ . <br />' , - <br /> SAMPLE <br /> MEASUREMENT <br /> - ` y, / , <br />...: <br /> REGiYRtl7eENT <br />, . <br />- <br />Y 3T'. <br />•993 ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnFY UNDER PENALTY OF LAW THwT I HAVE PERSONALLY E%AMINED TELEPHONE D A T E <br /> AND AM FAMLNR W?M THE INFORMATION SUBMRTED HEREW: WD BASED <br />•,~ <br /> <br /> <br />^ <br />' ON MY INOl11RY OF THOSE WDVId1AL5 IMMEDATELV RESFY]NBIc' F FOR <br />OHrAWING THE WFORMATKJN I BELIEVE THE SUBMITTED INFORMATICfJ LS <br />TRUE ACCURATE AND COMPLETE I AM AWARE TNAT THERE ARE <br />ATI <br />P <br />F <br />fTT <br />SE <br />l1d ~ ,' I <br />~ (L// ( <br />/. ~I - <br /> <br />~ ~~ <br />Q <br />// <br />~T - <br /> <br />/1 <br />T ' <br /> <br />y <br />/ <br />(/ <br />/ <br />~ A ~ • 1 <br />'D'' F <br />' <br />' yGNIF1UNT <br />ENALTES <br />OR Sl1BM <br />ING F/LL <br />INFORM <br />ON INCL <br />NG <br />E AND <br />RISON <br />T SEE IB U <br />f 1001 AND <br />HE PO <br />TY OF F <br />E <br />S <br />C ~ ~~ ' <br />, ,( <br />/ <br />. / T <br />SSIB.J <br />W <br />YAP <br />M <br />N <br />. <br />. <br />. <br />include /inu u <br />33 US <br />G f 1319 (R <br />d:iu und <br />/ Nue ,M1IUn:J me <br />!p SIGNATURE OF PRI AL EXECUTIVE / <br /> . <br />y <br />n <br />o <br />0 <br />S R O <br />HOR <br />GENT EA- ~ <br />TYPED OR PRINTED y<,rs) <br />fId000 ,nd or rtu,imum impnspnmcn! o/ beswcen 6 momhs ,nd OFFICE <br />R AUT <br />IZED A NUMBER YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rrkrrncr ell e(ferhmenls here) <br />SF.TTLEAbL}. :;OLZD3 Li9IT 4ILl. 6r. u4TYE-i: }'f+P >I^Y3,2:.I:i ia.::~!? :.'r tlT-.°.EF I..~.1(D)~ FG Y, FOR RF.QUIRE(1EKT5. <br />QaTRLY 5AGPLItIL: INSTBUCTZONS-I.C.B, FG YI• ? UA'i k.Yr, ,5 liCGl'.F;S: t-ON^.'NLY aVG -URtNG PERIdr REPORTED. <br />EPA Farm .3.320-1 (RSV. B•BB) Frevals ediUms l/18y LX? l6BA. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED! ~I ^ ., ,' 1 ~ 7 ~ n pA~ OF <br />