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PERMITTEE NAME/ADDRESS pnclude Farilin'NameJLOeahon ijDiffnrentJ <br />NAME <br />FACILITY ~ ,~ y ~i L` ;. _ .: -. l <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOESJ Form Approved. <br />DISCHARGE MONITORING REPORT (DMRJ OMB No. 2040-0004 <br />T. :: .J . <br />PERMIT NUMBER DISCHARGE NUMBER <br />1 .i .. <br />MONITORING PERIOD - . _ .. .. J - 4 ~ r ~' ._ : t, ', <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ TO "l i it _ ~' T . _. ~ p 7 ( ~ ;r: ~r <br />~. NOTE: Read Instructions before~pleting this form. <br /> QUANTITY OR LOADING pUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX OF TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~a-ysf5 <br /> SAMPLE ~ . ,- .- . r , .. - , <br />I ~) <br /> MEASUREMENT <br />' J +.! 1 / a PERMIT x*a#.aaa ###S>:~a .. ,5 alaaaa# ,6 'a ?: E <br />- ' ~'S;EY7 <br />;' i.'I i '. 1' ~~ J.; .-- V A i. 'J tl REQUIREMENT ., r ti., , <br />. <br />:i.I..:=.e ..`f'~.L SAMPLE ..., .. .- ;;:r,+.u.t •. ,t :k.:Cir 1 ~ ~) <br />I :, ,' - ., , :. -, MEASUREMENT <br /> <br />! ' : i J 1 ) <br />PERMIT <br />ak##Ke## <br />~+D!;~RV6#k ~ <br />a ~ <br />':-r;QttF#~'ID!# ~ <br />~?' . <br />0 '~^== ~ <br />' <br />- O <br />lf~ <br />~' _ _ <br />~ ~'!~ <br />r ~ I' ~ 7 0, f, ~" REQUIREMENT ~ ~ . _ _ <br />,t. . , <br />, ' <br />_ ;i.i `~i, ., PfL='''.iL' SAMPLE ~ .:_t •. .. j;r.;:-:. ( Li) <br /> MEASUREMENT <br />J J I'` L i U PERMIT #4r#### ##+M### : -:. fp###,tgt1:: REPRH~`' "; ''. E(g~POR`L':. 'm ~ .:. <br />~~~'. <br />.'!~LJ:'::f ~.. .J3~' YdLCh: REQUIREMENT 30' +, . <br />- - ;H~:'~:, SAMPLE ~.. ar: ,rr-[: rt~r,: .:::;: ~ 1+,) <br /> MEASUREMENT <br />J :-, :+:~ 1 J ~ .PERMIT ~'###?RR ###Iltkt# -. ~ "[c##### ~x4#+OItR# U ..~ ~ t" ~I11 ~ <br /> <br />'' f :. ii .`; + 1' .. 't J,i r V A I. U c <br />REQUIREMENT <br />~ -n <br />~ <br />- - . <br />'.~, 1',Ii .'r .. SAMPLE '~ ~)kr ,tr ;~:`/: ... ( Ln) <br />1 p ~- =' :,) MEASUREMENT <br />., a'. 1 J J PERMIT ##g#fip .g#IC#faA ~,. {+ukgcl6tikO ~ ... <br />.~- <br />U - <br />. Q <br />~++ <br />_ <br /> <br />~~~ <br />.. • r !: -.. 7', - V A 7 ..: REQUIREMENT .. - g," <br />1', :M1 .: l\_~.. _)'~ SAMPLE ( tyj) q:k r,.>F#^ #$:k': ek .k .:. i. <br />+ ~ ~ ~ .i ., r; ; V L ~ ~ r• MEASUREMENT <br />J~J 1 J PERMIT RP,:POBY ~:'~~pQ~rX':'-.+ j`>il -'~~# `-'$Q!~!~N~ <br />~?. `'~"ytC.'a'+tiY S'' a{t '~~ s" ~ ~-3'?"A5 <br />F 1.' C~• T ~-. ill :': REQUIREMENT 3UUp AY;, C~ .LY III „GD . ". ` k,:k , ' , <br />, <br />. _ .i ' . ' + SAMPLE .. ... ( ,I ~) , ,. ... .... ... .. , . <br />~ _ ~ i ;, MEASUREMENT <br />.J-~'. 1 ~ PERMIT O#CKeR# Y F.', ; #dnOt##g <br />_._ _. ._, - 3+S*~###,' <br />-.-,. - _. p+k -.. f+ka <br />:_ {f <br />, <br />.PFfj <br /> <br />~Sl~#L <br />r L I',: T „ -i +`• 'J S1 ti? REQUIREMENT- _ ... NS -- A$ r _) _, a; <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICeniry antler penelry of law Nat this tlocument antl all attachmanLS were <br />re <br />eretl antler m <br />dnealion or au <br />si <br />msion in ec <br />ortlance with as <br />stem tl <br />ned ~ TELEPHONE DATE <br />( <br />' * ~r~"! :~ S 7E ~ p <br />g <br />p <br />y <br />pe <br />y <br />c <br />e <br />to assure that quali0etl <br />xrsonnel <br />ro <br />erl <br />ather and evaluate the information / <br />~/ <br />~ <br />~ l <br />p <br />y g <br />p <br />submmetl. Based on my Inquiry of the person or persons who menage the system, - <br />= <br />~~'~~(~ <br />~ <br />~ <br /> <br />c ~__ I <br />or those persons tliracUy rast:onsible /or gathering the inlormal'an <br />Cta Inlorma:ion ,^ <br />« J <br />,.. <br />F- <br />~ , <br />submitted Is <br />to the best of my knowleoga and belief <br />ecmrate <br />true <br />ana complete p <br />~~ <br />) <br />~ <br />' <br />_ , <br />, <br />, <br />, <br />. <br />I <br />th <br />ifi <br />en <br />lti <br />i <br />t N <br />i <br />t <br />f <br />b <br />im <br />f <br />l <br />f <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE / . <br />~ <br />j <br />j O / [J 5 U <br /> <br />TYPED OR PRINTED am aware <br />a <br />ers are s <br />gn <br />can <br />p <br />a <br />es <br />or su <br />m <br />ng <br />se <br />n <br />orma <br />on, <br />a <br />includin the ssibili of One antl im r~sonment ror knowin violations OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />UUMMtN 15 ANU tXYIANA I IUN V h ANY VI V LA I IUNJ (Here/enCe BI/ eR8C0men(5 OereJ <br />.:,., :'J'fAL :? tr: LI .. .. •tL!. -. _. .;t' ~' .5'I - ... '.'.i.:5 L_ .. -. F' <~ ,. ~ ~ _ <br />_. I , ~ ... I ', . <br />,.,, I. P.. 1, ,'~ C, fort .. ~ _ ...::5:. JIL .. ~...':,_ .., ..~TT~i-..::E .• ,...', JII. _ ..: ~ ';,_! , <br />EPA ~"oivi 9320=1~( EV 3 9J)` Previous liaitionsf may be used. P J ; ~ _ / (1 ., _ J 'THIS IS A 4-PART FORM PAGE OF <br />i <br />