PE
<br />T7EUyNAME/ADDRE$$ (delude FacBlry Nams/Lacation iJDlBerenQ
<br />E CYPicUS [§M~4 Y#LL''Y ~~#[. CDR P,
<br />ADDRESS'IIV'.S 1.,2%3 ;DDTN, !; ~:=R'fAN PK
<br />y1•f,7 °AST '~IN5RSL "L P.C!.°
<br />?••GL=aDnn "'~ 911155
<br />FACILJTY
<br />LOCATION
<br />Arrv: v~)a~•rs ~+. rrr, T.T~, ;c;,~4AL 4T4!
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(Z-181 Or- BI
<br />^17D77151 MA ~
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '1:1 ~ 1 TO ~, ' ~. 1
<br />f16z11 Rs-z31 R4-zsl R&srl Ra-s9) (3031)
<br />Form Approved.
<br />x ~ 1 ,t ~ OMB No. 2040-0004
<br />Approval expires 05-31-98
<br />r ;rrn~ .r..~
<br />v _ cam. eT n~1t~•
<br />MT ^i •• 7 nnv~n P TlT cnT nF, t. rn. :•v
<br />-~ ,
<br />NOTE: Read Instructions before completing this forth.
<br /> (3 Card Onry) QUANTITY OR LOADING (4 Card OnN) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46.53) (54-Bf) (38.45) (46-53) (54-61) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(CtGT) 'tea-~!S
<br />(64-88)
<br />6&70
<br />JD SAMPLE
<br />MEASUREMENT -': ...-.r azx~: ~~(„e Ll- .•t .,; :~,;• '~ 0~
<br />~j ( ) 1) ~ JI!~ L-~Y~t~
<br />ODuU~J L D ~
<br />-
<br />PERMIT-
<br />-
<br />+ s
<br />- avc li'.~&,~~~;'~'° -~saW
<br />~ Y"~!r':.r,~~ ',
<br />~• ~ Y E$RGT •!?k
<br />z"
<br />£FPL!I?kT SRDSS v3LOF -.
<br />REOUIREMEN7 _
<br />= '~' i
<br />:~~~ 1F~x: ~
<br />~ ~ ~ SD
<br /> _ ,! ~
<br />x .
<br />. ~
<br />J L DS, ~ '_1' SAMPLE F+RiRR R.1:R'kS~ b+?GR=S~ ,,``
<br />~Q
<br />~~A ( )1)
<br />A
<br />~~(~ A'
<br />n
<br />SUSt1~yD':D MEASUREMENT N n N V
<br />DDS30 C 7 7 ~ _ _ Igo- r. .c ~x 4 ~!l~C3RT R 1/CP/ r, _
<br />~
<br />k: C7!!°-!IPS 9°L'l~
<br />S F :fiEQUTAEM~NT ~. '~-'_ }
<br />.;t
<br />i - Y,eG7R '
<br />~~"~' ~"
<br />~~' #~a r
<br />R
<br />• +1G/T !(Tf$T:11: ~~tr~ •1
<br />. - ,
<br />= ut
<br />t +. . .
<br />, .
<br />w u',, CJ SAMPLE cacar-^ G~`.R-- ~r-an--x ~ ( ( 19) ~ 1
<br />/Z
<br />~~
<br />S U S P E 9 D •' J MEASUREMENT ~ ~J
<br />~ ~ _
<br />00530 i ~ ~ ,~ ~
<br />rr~:~ERMIT a, ~ ~ ,~ a,.a
<br />- ., ~!t#~Y
<br />y~iw ,q ;~ .;-
<br />7.
<br />w9
<br />,
<br />~
<br />6PFLUE!t°' :.R~Si YAt9E I
<br />HEOUIiiEMENT
<br />.. '.r
<br />.+, t":47 "'`
<br />DU JJ, ~... -. F. :~~; ,~• SAMPLE SC GX;<•7 R.SSS f,Yt;:S~~t ~
<br />' NIrL~ ( n Y' ~ N~ /v~
<br /> MEASUREMENT /-F
<br />t
<br />DOSuS o ~ 7
<br />I awsa>e=- r-+~s ~~.
<br />~ ~ ^~=1L1~' - "-
<br />~~~~'~~ " . .
<br />SE¢ COMMENTS 94LDV ENT
<br />~R 1AE _ • ~` '
<br />~ .~
<br />LLDS, SF,I TL P.#9LF EMENT ';YO~Z~ D$lx$~ ~~~A~~ O L
<br />~~ ( ?S, 1/2-I ~~?
<br /> MEASUR l V
<br />"
<br />[§0545 1 0 0 ,~ ~ ~._
<br />ERMh ,~ ~ ~ ~ # _
<br />yY
<br />• x~=i '~1 ~ ~
<br />1t'
<br />: t X1'4':?
<br />N[ ~. n t RC' '
<br />_: .,
<br />
<br />F.P~LUEN? 6RD55 YALU>: {
<br />OUIREMEryry
<br />.._:~ G Sb~{~.- t~~
<br />' r ~
<br />• r•f[,
<br />.~+
<br />~' ~0~~ ~ *~~
<br />4
<br />~s ~~~ *
<br />'
<br />1111 ~
<br />NL/L Ce ~ $ -
<br />w.~
<br />U L G I.NC JE SAMPLE t
<br />' 4F iRaR O~GCrlt? ~ t@:*'Y+S:
<br />NA' ( 17' q
<br />/JF
<br />ILIA
<br />NA
<br /> MEASUREMENT
<br />00556 ]. 0 D ';" F?ERMIY °. ~ " r ~~ aat ~ ,+~ ~~ _, k -~" ~9 ~ 4~ ~ -~1 -
<br />EFFLUENT GRDSS V#L'7 9EQUFi~MENT '~ -
<br />:`
<br />k,
<br />~ x4P~ 1'~$~ #)~k= tiG/L ,<~';• ~`-: ~, :
<br /> b_ .
<br />_,, .
<br />5
<br />, .
<br />LA I , A . SAMPLE ~Y-EKES R;vxtgf, k#'-'+Yx,~
<br />hI / A
<br />~ ~ n ( 1 9)
<br />N~
<br />N1~ "~
<br />N~
<br />(# S ~ °) MEASUREMENT /
<br />.
<br />D L ~~ ~ 5 U ~ 7 ~ FERMIT', t~ +~ ~`, aY = #s~i .* " ~ $~"~ ~. ~'~1~dR' ~` ,: ; ~ ~_ ,
<br />SF. .. OfIM;:grS 9 .LJW FiE~UIREMENT ,'-~. ., ,~ ~ ~ ;. - =34p~ -~k?~ R'tC.LT ~!-` nC/L - 1} ,,, >.
<br />•NAME?ITLE PRINCIPAL E%ECUTIVE OFFICER I CERnFY UNDER PENALTY OF
<br />T
<br />E INFORM LAW THAT I HAVE PERS
<br />ATION SUBMITTED HER ONALLY E%AMINED AND
<br />AND BASED ON MV
<br />EIN TELEPHONE DATE
<br />
<br />IiIII AM FAMIUM WITH
<br />H
<br />INQUIRY OF THOSE INDNIDUAL
<br />I BELIEV
<br />THE INFORMATION S IMMEDIATELY RESPON
<br />E THE SUBMITTED IN :
<br />SIBLE FOR OBTAINING
<br />FORMATION IS TRUE / ///~~j,,, ,,,,,,
<br />( n
<br />~ //'/
<br />S
<br />4icharTi , , ~~
<br />'
<br />~
<br />- ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT f ~
<br />\ // /// / 97D-87D-27L7 ~/
<br />Ad S18 C]PI
<br />tllV11"O"1NPil tR1 PENALTIES FOR SUBMfITING FAISE INFORMATION, INCLUDING THE
<br />/~/ 7
<br />J
<br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C.
<br />' SIGNATURE OF PRINCIPAL EXECl1TIVE
<br />
<br />TYPED OR PRINTED es under Nave smfules mey Include Urlav up m f10,000 end a
<br />§ tat B. (Perem
<br />madmum impnsonnrerR Ol belreen Bmonms entl5yeers.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />``cp.
<br />N*
<br />i
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
<br />AIyTF.3~IlT~' LL"Ir5 FDA T3 S, IR7N F, S?rTLP.1RLE SDLTf15 (L7' •n') #~PLT D'+L[ TP C= LD-T n, ?'I-Pn ^R''^TP °V"c^•
<br />LS, ."L3i1t:1. SE'' I.#.2, P' LH, PDR 90RD?Y 7P PRODP ^£)7L~F,YO11••S. ?TL ~ G?EASP,-SP.F. F70't'NOTr r/• p.• -1•
<br />TYI -A '' " C or nnat.~a^ rrc wo..^. ~nuv_vnnwun-.. ..•
<br />EPA Form 332p-7 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ O T 3 5 / 0 9 (1 b1 2-1 ~~ 7 d PAGE L OF
<br />
|