|
PERMITTEE NAME/ADDRESS (Include Facility' NamrJLocarion i/Or(/erenq
<br />NAME rvr v. ,... •.T ~ ,.. .,
<br />ADDRESSM I .J ` ; T . 7 E' + ~ ••'- ~. .., • G r ;~
<br />• ~-
<br />FACIUTv
<br />LOCATION
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMA;
<br />(8-161 f1]- 91
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ' ~~ ll TO "~ ^l ~1
<br />(2P2r1 (8229) (2425/ (26@]) (2929) (3P31)
<br />Form Approved.
<br />„ ~ • ~ _ OMB No. 2040-0004
<br />Approval expires 05-31-98
<br />• ,
<br />NOTE: Read Instructions before completing this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FAEOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) (3s-45) (46-53) (54-s1) IX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(62{J) ANALYSIS
<br />(64-68)
<br />69-7D
<br />;. ',; SAMPLE !p ^: fY n r : F s Y ~ h. [: .. ..... ... I ', l~
<br />\
<br /> MEASUREMENT ^ , (~1, rl `I +
<br />• °,.'/I
<br />U ')1LtU 1 U ~ PERMIT. oQs)t grQQ QRP#4Q Q t'-~ 6.5 #0.'*dtRitb"' Safi 1C ?R~",t,'(! •R!1 P-.
<br />FF'I,1Jr tiT ;;p153 7'1.-!; REQUIREMENT :'=i.a :ah i>rl
<br />Mt#TFlJ
<br />n±tiY~+etFs
<br />~,. .. ".
<br />~7:,i^5~ +'n^.4 (. SAMPLE '.s r,:ar RC h;YG¢/,: .: f,~^x-:4.4.?: ~ t71
<br />11 ~ P f' ri (" !. ~ MEASUREMENT nl (~ ;\/ i\ ~~ ' `1 ~ `• ~ '
<br />GO`7U U (? ~ PERMIT`.
<br />" 7` rA'IOod rx AI IrrP~PTt 4 r.tM1 "IIT4pa+M~C "' ~
<br />F"-h'-'
<br />-n~Y
<br />R~R"~§F~-~
<br />,-
<br />-ter t~
<br />eR R
<br />~ .;
<br />~
<br />rn yw..• Y.^ G.•
<br />C'J .~: .i. r P .')a )'
<br />~HwEOUIREMENT
<br />:f^rv- .
<br />.;(yJ~R ~M~
<br />AIItL-~t'' RI<
<br />'^(:!i, _
<br />-
<br />~R i
<br />~
<br />.km
<br />;•n:.T D~, ?0°4L SAMPLE .': (:Cn r.: •, r. ,~r: .~Yn r: •:
<br />~ T r~~
<br />1 ~, I
<br />
<br />'
<br />`: l :i i~ V 7 r7r MEASUREMENT !
<br />~.' J ~
<br />C()537 1 D
<br />.l
<br />3
<br />,e re nrXrA0.
<br />~
<br />r ' P:'t S+Ce O
<br />
<br />~ -^.:C :; dO:?`rknr. 'tr an (r NC,'P/ ~# ..
<br />C c..~ -•~ r tc
<br />'~ 1•'. I
<br />>• ta.
<br />.T L.N REQUIREMENT ~
<br />n s':,, -~n-:r. vnat AY^ x rr
<br />~rT~ •-•. xI0y7R ~
<br />,1
<br />. _
<br />. ,
<br />~JLIUSa ii:T_.!•"r..f? SAMPLE "`'::.yr.D r.^^rer•: ;~.^..... f '~1
<br /> MEASUREMENT •1'" '
<br />~OSItS O U
<br />PERMIT p"tiXQRQ asaaa+x, #'<r: IXt%KtGnt tiS!!1rq'r+ .S
<br />(l
<br />1C1`/ f
<br />$~~}"':
<br />. -
<br />;' CO*'e4'"'"° ' '" n'~
<br />REQUIREMENT
<br />~ ~u"~4~- -e.rrt
<br />.a- ~pp>, Tly^- nfT[T*I "T,/'. +tnNroa
<br />SOLSDSa _i r:^'. Ln C'r. ("v SAMPLE f4 ^re rrn-. R4~FO" '.'., .".t / ^r,l
<br /> MEASUREMENT ~ ' _ ~~ ~ '~~ i- "" ~
<br />~U`.4'T 1 7 r PERMIT R4G91QQ 4p46a1? ek ".'^? RIQAlrMO R*_pttP'? !#al~,~~. T7 k?'L~/ R $~~!
<br />-F'L;IC~",' "~~^~ V""; " REQUIREMENT ':~'•Crs ~f~~~` t~ D1T'[: ..i.li "!A!7'hTr
<br />~L'. ': 1:u":,5 SAMPLE ..~...nF:- ~;2rvr•.. ,.,:drt~rr Y•.nr-nom c) ~ ( "J)
<br />
<br />MEASUREMENT
<br />
<br />-w-..Y t.
<br />y I
<br />~
<br />"y-,-r _
<br />V ~
<br />JU`9~b 1 :7 ~ PERMIT 4:`,rISR4 'SORQQ# ~ ^.':^ A'!rQ#Rtb' IKdtRtlt#t!!t (~
<br />~ ~ C 11'!'j'S'
<br />FcLlr ~.NT C; 75" sT "r REQUIREMENT ^•.«Cr rNt* P-[ wr-1
<br />T- r-IN ~-
<br />.. ..
<br />•: ~: ;'~ T'OT=.( SAMPLE "f-':rv •. r, r. r. ...; .; :; ...Y., ..•:... ( ' ^~
<br />(.t _; r = 1 MEASUREMENT ~ ) 1` ~--')
<br />.,r
<br />~~
<br />DiC45 ) (' n PERMIT rtn~'F CSR nRQCr9 T' ry ...... Q:'~C+6rA# arpnu* ~@"6$"," q SC°~ I Rd~1l~=:
<br />' - :- ~ t" ^!'~:'. T' ' "" "- REQUIREMENT ~~.,.,y
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />ATION SUBMITTED HEREIN
<br />AND BlSED ON MY TELEPHONE DATE
<br />
<br />~ INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE,
<br />iills
<br />F?Ichard I ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />E I
<br />MAT
<br />ON
<br />CLUD
<br />THE r'~? ~/,`// 97O'S7O-2712 O2 ZS 00
<br />Environmental 1~^ana er
<br />9 PENALTIES FOR SUDMITTIN
<br />POSSIBILITY OF FINE AND IMPR NFOR
<br />I
<br />, IN
<br />ING
<br />G FALS
<br />ISONMENT. SEE to U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF P INCIPAL E%ECUTIVE
<br />
<br />F PLII p § t3t9. (Perreltias antler mesa statutes may inclutla lines up ro 510,000 entl a
<br />marimum ~mprisonmenl of belrsenemonths antl5years.) OFFICER OR AUTHORIZED AGENT
<br />p
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/eTence a!! attachments here)
<br />r.L~:~HT: i,„* (.I"I' ^T ~ ^.a ir:1. r c..FpT ^71tJ~ ;~LTn^ ~T'1" .n.T §.. rTV •inTV T=' C= 1n_i'., ..I_Ir. 'f-TC ...r o.r.:.
<br />T CLA:°:EDa rc~ '. .. 'a p.- Lqa rT.n ~')~•f^q .)P t•^^. Inn scn(rTa c.. .. r>..~.-~ ~T• r, rr~ rl / :'I'
<br />r v r Nrr c •.-n..-+.
<br />EPA Form 33207 (08.95) Previous editions may not be used^ ~ ~ ^ (REPLACES EPA FORM T-~ WHICH MAY NOT BE USED.) PAGE OF
<br />nnilgln~p,l>>_~r,tl i
<br />
|