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PERMRTEE NAME/ADDRESS pxlude Fanliry Name/LOCadon lfDigcrenQ <br />NAME CTP~(US !A`?PA PALL°T '?AL ~'IRP. <br />ADDRESS?",IN ES 1,2°T `r O11 T'TI, ~ F.C!'1lN PR <br />9100 PAST 1TNF,P.AL "TR^LE <br />F9GLF:Y709 C'J 9')T Sti <br />FACILITY <br />LOCATION <br />AT'C~~: Y0~73I~ V. I F'~??.FY, .:PN4PAL PTNT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCNARGE MONITORING REPORT (OMR~ <br />(2161 ftl- 9) <br />"1n~ -t7 SG !1r17 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ ') (L 7 l TO D D n i a l <br />(20.21) (12~ZJ) (14-251 (2&2]7 (28-28) (3P31) <br />Forth Approved. <br />~ ~ ~ ~ OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />v _ c~••r• a~n .~ <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53 (5461 (3S<5) (46-53) (54-6 /) EX OF TYPE <br />(32"37) AVERAGE MAXIMUM UNfiS MINIMUM AVERAGE MAXIMUM UNITS rye-rn) ~BSlS 69-70 <br />:, f;Y r'ti.. ;i, gTl'A- r!AY SAMPLE Q?Gx3x ".:3RP~~: titxr.« !:t ;:;t d:;: ( ?T) <br />4 R C R I D D A P M v T A MEASUREMENT ~l ~~0rp ~ ~ Q1 yrill~ <br />iC('3U S i) 7 pt <br />~~ <br />~ r1.c ~ If rV <br />SEt: COM'1 ~::JTS al°L )a REQUIREMENT .' ' Iiq"* <br />i <br />~ K+#:# I ~^'- " "t <br /> f <br />,. t:PPECT_ :iTS Tvp IL .`Y SAMPLE 43#?#O #grGRrY +,r+.,F ~#it,*~ fk lk #:t fir- ~ ?T~ <br /> <br />U H R P I "! E t' H i L l? ~ <br />MEASUREMENT <br />~/QQ <br />O <br />~lq~ ^ <br />YR~B <br />PCPbC 5 U D 'pE{~MIT - -~,~' '3 `,°'S ,; #?" 3G? :"#1b P,R- <br />~`~1L ~ , <br />~FE CO•tl?":TS F:'1.7) REOUI~REMENT n ,.:- r ;, ~ sd 4~R~G # Ra. :* r! <br />';s T <br />fv ;,~ «7 <br /> , _ <br />. y <br /> SAMPLE <br /> MEASUREMENT <br /> .' ~-' <br />_ ~ +~ <br />+ <br />+ <br />a-~ <br /> REQUIREMENT - - ~ ~ -:'- <br />1 {. ., <br />_ _ <br />~ <br />_ <br />y <br />~ <br />~` 4.jFi-. <br /> SAMPLE 1 <br /> MEASUREMENT .. <br />. <br /> , I: ~ <br /> ~ <br /> REQUIREME~.. F ~ ~ '~~' ~~' •* '~~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> MIT' <br /> <br />~~ <br />~ r' ~- <br /> <br />'s~ <br />r ' <br />; - a ~ ,~: A(;~, " <br /> <br />_. ~ ~ '~~. ~ 'Ff ~` <br /> EMENT~ y 1/F~o- ,t~ <br />c ~ <br />~ <br />k" ~ ~^~ I t/ <br /> ., . <br />oa 1 <br />.. <br />: .F = <br /> SAMPLE <br /> MEASUREMENT <br /> . pERMITI ~ ~. ~ rt tsc~r*'3" <br />` a ~a u ~+ ~ L+ is q~v }s .,~ - <`.:.: <br /> E#EOU~iEMEN7 ` ~2 ~ r"~y,~,"„~~~x mac:- '~,j tt. ~~ 'S'' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> -;PERMI~~- <br />ENT <br />U <br />~ <br />i <br />~ :. ~ ' <br />'~ ~ <br />~~ <br />~ <br />~ <br />yx. <br /> REO <br />IREMI ~~ ; d <br />,'~ .,~ <br />~ ,., <br />. <br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF <br />ILIAR Wm1 THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDMDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br />~ ~ <br />. 11~~$ <br />Richarc THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, <br />, ACCURATE AND COMPLETE. <br />ENALTIES F <br />R 1 PM AWARE THAT TH <br />FALSE INFORMATI ERE ARE SIGNIFICANT <br />ON <br />INCL <br />DING THE ~ ,/ 9]D JJ7D-Z7) 2 <br />I'cIV IYOnmenLa( h:lana~er SUBMnmNG <br />, <br />P <br />O <br />U <br />PD$$IBILITY OF FINE AND IMPRISONMEM <br />SEE 1e U <br />S <br />C <br />§ 1001 AND 33 U <br />S <br />C <br />~ <br />~ ,~ <br /> . <br />. <br />. <br />. <br />. <br />. <br />. <br />000 entl <br />m t10 <br />~ hires u <br />e $IGNATURE OF PRINCIPAL EXECUTIVE ~' /, <br />TYPED OR PRINTED p <br />, <br />a <br />m~mumm~mm~irt o/mt.ee 6m <br />orNnrentl5 <br />^ wms.l OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell etlechmenGS here) <br />S£2 I. R.7 FAR TF;T PAO^^D!JR'. RPT oP,SULTS 7F L?TFiALI*T 7ERTVA°TDyS qS ^~a1.pF^,•r ~-^rl'dTN F, RQpRODt1CTT'Tv <br />, <br />D~4IVA'PL]`•S A:i "iJ•ICTTT". RPT COYEST r ?FPI. AT aRTCR STATTC°TCALLT ;TCIITP DT°L' ~ - ~PD1T TvST 4 C;)v*R-lT. <br />Vie nuc oo~.run nc. u.- wns .-gyn.. r-s ~r..~c ..~. ~.. ..^..~ .. -. .... ~..~ ~~.. _. ~.. .,. -~_ _ T---_.. "_ <br />EPA Form 3320.7 (0&95) Previous editlons may not be used. (REPLACES EPA FORM 7-40 WHICH MAY NO7 ~E USED.) ~ - ""`~ a ` `~ ~ ' pAGE• n'OF <br />00).66i99nN7?-.52n J <br />