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'ERMITTEE NAME/ADDRESS (Include NATIONAL POLLUTANT D16CHARGE ELIMINATION SYSTEM (NPDESJ <br />FirLlry N~~~mepp/Lxulon /! dl7errnll DISCHARGE MONITORING REPORT (OMR) <br />VAME~^'.iT~i~~'SLE~Is~~.)~..Ql.~~-~5.~-~- --- (1-161 (17-19) .'7 .I ,V7~ <br />GDDRESS Y I ° ~ _ ~ OVed. <br />N~-~+~IrJ~ tiI•?1~---------- COGOOGJI3 U~5 ~ (SUER irC) 89N'SAPBr <br />_ - - ~ Q -~~ y- _~ _ _ _ _ _ _ _ _ _ _ _ _ _ PERMIT NUMBER olec.wnoc NuNece 'r - F I ti A 3. OMB No. 20a0-0OOa <br />lI A ~AA~II _tlA .~ <br />-~~~ --------- ~~"J~`L-= -- <br />'AGILITY MONITORING PERI00 Y~YU rl 'J SIUf f'TV[1T.]-'1'01 'CL'G -v nnw <br />_ _ _ _ _ <br />YEAR MO DAY <br />YEAR MO DAY <br />=OGATION __ _ ___ _ _ ___ <br />FROM TO ,~fi~t ~ <br />NO DISCHA~ GE - aaa <br />_ <br />t T T N : R . I. A 9 C F.. 4 A D E' f': I N F. C A N A G ° }i (lo-al) (za-1J) (~4-1s) (ls-a~) (78-d9) (JO-Jl) NOTE: Read instructlons before wmplaGnB ~e form. <br /> (J Qvd Only) nUANTITY OR IAADING (4 GW Only) QUALITY OR CONCENTRATION <br />~R~o <br />+C <br />PARAMETER (46-SJ) (54E1) (J8-45) (46-53) (51.61) ~; Y <br />~ <br />~'~ eTMPPfEE <br />(J1-J7) - <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS (6T671 (646r)- (6170) <br />~H 6AMPLE i.: I ix':;x^: ..:::t:t v ': 'x ;: x}1:: :":: ( 12) <br /> MEASUREMENT _ <br />I <br />)G/+GO I D G PERMR. a#.'S%:41OI . ¢#fJIIO#+s :::::' (). J_ _ ..._ .. .'-_,;.:fa#a>x -' <Je0 '- ~' .. <br />;FFLUEN: GH05ii YALUB 1°Enu~'~' _::: -'~ nIXItfU(1 ttAXItFOR SU ' ~-:" .+~'. <br />:OLIDS, :;ETTL°_AfiL`: SAMPLE ~"ll^"~a'A` '~'•"~'~••"t ( 25) - -. <br /> MEASUREMENT ~ ~ ~.' ' <br />1o5u5 1 V ..G PERMIT #dl><I#a# ##aa#a - Yi= PTIA.NAL R£PART , Q.5 ~,. ~ ', <br />iFt'LUENT GROSS Vn:.S;t; ~Q"~E"IT •-- NTR AVG 36DA AYG DAIL. !Ik CL/L I <br />!IL A!I(1 (~F<EAS:: SAMPLE x::i}:::{I::: 11 Si s':xt::.x :y3:i(:{x~: hfi4#ao ( 14) s <br /> MEASUREMENT I <br />)35b2 1 J v PERSiIT #x?+~G## <br />~ r7lblly4pte :t :;x .; r:aa4a:f ##a### - x0 rw '~ R. <br />* <br />?FF'LUENT GRUSS Y.4LUE REnUIREMENT ;y r:ix;x IN82`~ AA '1G/L ~ ~;IET' - .- <br />* <br />'L01i, IN ~OYDUIT IJR SAMPLE ( 1: 7) 4st l/:1'I :: :FwC04ix #if#n~+t <br />'. N R (~ T R E A'I IT E `7 °. PLANT MEASUREMENT - d, <br />IUG'~0 1 0 0 -~~ ..REi+ORT fiEP.AetT ~:aa>,xaa a#oa#a pli+0=j(tpal us# <br />~ <br />~` <br />~ <br />iFFLUENT GRO55 VALUE I~awr+EMENr 3GGA APG DAILY ri% `1t;C ""' ari4a ~ <br />~ ""' <br />• <br />•%; <br />, <br />;VLID;, TOTAL SAMPLE x,r,,n><:t;l i:,~.k*...I# a#:; :,~==:: ( 19) - da <br />l I S SOLY E 0 MEASUREMENT .',f <br />'0255 1 0 0 . Peanar asaaa# #aa~I+~# :x r,-::: as#~:tfrl REPAR~ OP IA L ~ ;; <br />:FFLIJcNT GRO55 YA..O feEaulRaMENr: .. t:r,::;::: RTR AYG R1rR AE Mi;/L ~+ f: 'iti~ f '=~~.a <br />)IL .ANO Gii :ASE: sAMPLE f:±;lp;;gx'; ( 94) #OaLt,::;: ::<iYa+:la.I #aaa## - - <br />U S U A L MEASUREMENT _ <br />iu066 1 U G reR~nr `- aaaaaw ss=1 aaa#a# azap:aa4 :_. I~nal~pf!a~a.:- <br />.~„ <br />. <br />~ <br />' aa# <br />:F6'LUENT =:3055 VALUL: i+eouweifENT INS'!' :TAX =0 .'.+ <br />- <br />: <br />. tl3aa ' _ <br /> <br />SAMPLE ti <br /> MEASUREMENT <br /> <br /> <br />NAME/TITLE PRI GIPAL EXECUTIVE OFFICER I cERTIFV UNDER PENALTY DF LAw THAr I HAVE PERSONALLY ExAMINED )/ TELEPNONE D A T E <br />` <br />I 1)~Ar AND AM FAMLAR WRH TFE INFORMATION SUBMITTED HEREIN ,WO BASED <br />ON MY WOIpRV OF TFpSE WdVOl1AL5 NIMEMTELV RESRJNSBLE FOR ~ I/ ,~ <br />//- <br />/ <br /> <br />/~~ OBrAWINL THE INFCRMATI[Yy I BE4EVE THE SUBMITTED WFORMATICN IS <br />TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE AqE <br />FIUNT PENALTIES FCR <br />UBMfrTI <br />G FA <br />SE INFCQMATION <br />INCLUpNG <br />SGH ~` <br />~~ ~ ~•~.' <br />~ <br />(y <br />I f, <br />/Ff ~ / ~r ,,I P! i . <br />I <br />S <br />N <br />L <br />THE fvSSIB4RV of FWE AND 'MPRISONMENT. SEE vB USC S Idol AND <br />'nclutle fmn u <br />]] USC f 1]19 <br />(Ibntlnu <br />tler Th <br />e mrurcs na <br />ro <br />SIGNATURE OF PRINCIPAL EXECUTVE ,~/ <br />/ /v ' /[/ 7 <br /> <br />TYPED OR PRIMED . <br />y <br />an <br />es <br />o <br />flOpW u1d or nu<imum imOrisonmenl of Doreen 6 monrfu ,IM S ye,rs) <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />]DMMENT AND EXPLANATION OF ANT VIOLATIpNS (KCINCOCC Ill BIIIGOOle0I5 OCR) <br />1TTL::AHLr. ~OLIBS LI9IT 'R'ILL i'c ~3I'r4G FUT `I::Y?,2~+rt9 i%ucCIP EvStiT.-3E';: I.d.l(D), PG Y, FOR RBCUIREnENTS. <br />(eTRLY SAY.PLING iNiTkUC'IIONS-I.C.++, :'~ t'I. 3~ DAY Lv'; I: Nlru :=T !50'/T!iLY AVG DURIN', Pi'RiOD P.FPORTF_D. <br />~PA 1"Vrm 3320.1 (RBV. B•BB~ REVIp15 Bd1Il0l1S fl1By DS USef/. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 - 1 v / n x: I ` T- I ~ ~ - PAGE ~ OF <br />