|
PERMITTEE NAME/ADDRESS Qnc(ude Faci4n• NQrtWJ(gCa(Inn ijDijjarrnq
<br />NAME
<br />ADDRESS; ~ ~ ~. ~;t,, ~ ~ ~, ~
<br />r, i. Y
<br />FACILITY
<br />LOCATION
<br />IEiY
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMR) OMB NO. 204'J0004
<br />.i;. ~-
<br />PERMIT NUMBER DISCHARGE NUMBER _
<br />-?':ALi°
<br />MONITORING PERIOD I' - J ~. , , ~,-: "'~ ' ~ F 1, J d ; d
<br />YEAH MO DAY YEAR MO DAY
<br />FROM ' ! 1 _ TO ? I , .' _ - ) +, . "'' ti F, r.. ~ `r °='='t
<br />. NOTE: Read Instructions before~aFripleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOOENC SAMPLE
<br /> EX OF TYPE
<br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 'w'A('~'(s
<br /> SAMPLE ~ ~ ^ ' ~ -' ~ - ~ ~ -~ { I1)
<br /> MEASUREMENT
<br />1 1 d ~ PERMIT ##040 AtP>aOKc4 R c. ._ , •'~ . ~C#4#+k .0.~ ~ ~`~ i~S~~U
<br />! K J ; '_ V :! L ,, c:
<br />.. REQUIREMENT ~y; ~ ~ I r "
<br />I J: n:.
<br />,.l ~; ~r SAMPLE ~:.Cn;: :F r::F#.y~,. { 1,3)
<br />~ ~• •, , MEASUREMENT
<br />' ,-~ SJ 1 ~ ,1 PERMIT ~tK4P~~. ., -~~#td~': . e:,~-c yt, . _. IIa# .~ 5
<br />~~ (f:-: ~,:E, "~f ". i~ $AF.F
<br />: I, i; ~ • '[ ; i : ~ J A i,''~ REQUIREMENT - ~ -' r -
<br />L ~"a .'F SAMPLE .. ~' 7•:.. _ .._., ( 1R)
<br /> MEASUREMENT
<br />
<br />~> > _~ 1 .% (J
<br />PERMIT
<br />a##>YYtxR
<br />¢V4;XO',M 4
<br />-.
<br />41t+###tC
<br />9th#i1rlOHD'- .r
<br />(f
<br />^. ~
<br />~
<br />R'AH'.
<br />r :":. J ': "' 1' !: ~:) S ~ V .; L I, r: REQUIREMENT
<br />.: - -
<br />.• ..,, .
<br />i ., e iJPn:. SAMPLE .. .. ~ c., m">v:-._~ (
<br />,.%)
<br />(p;""; ~I;) MEASUREMENT
<br />.. :, 1~ 1 .1 U PERMIT +k4>xGc~4 Drii'+R#aR7: q ': ;:^ #CG#dr# •5 ~ •0 D ~"
<br />"
<br />"(,: RAC
<br />.^' L J F. `r ~ ,; ;! U, 5 J A L U -. REQUIREMENT ~ ~ 3 C r~ ~ " l- , .
<br />.""r
<br />,
<br />r'' "-, It: _`~'!^fi P: ~~~:
<br />r SAMPLE ( r;;) :,: •`:p': ~~ ... -
<br />~. J ~ '~ c; t T"~:'% P L 1 :~ " MEASUREMENT
<br />_ ;.; 7./ 1 0 PERMIT Et$PJJST `8£~PDNC #4#ITr#r# a##~## .#4#~Cr~ M ,:;.. :3'~TEN
<br />;,Jg~ f ;,; );"; vp:.J'.; REQUIREMENT 3UDA""AY5 'SALLY "SX ' ~:~ - '"~~~ "
<br />_.. Vv ~ .....~. SAMPLE .. ( Sty) .:3-: ;~pit'.sp '~: te$:::,::~:
<br />1 ; r. ~ MEASUREMENT
<br />l::o i ~, ~ PERMIT ~@9rCtY# ~F_'~ E~=1 ,'~~.. ,-• -•~..- -^ *#if.~~:
<br />"" 'iq(Mf`#IIM'rdi
<br />.
<br />~'- #k "~~ ~- ~~dL
<br />_ 1."'f `:r-) ; J t _ (!? REQUIREMENT .
<br />INS" ~'x -r) "
<br />-,~: .
<br />,
<br />_
<br />`~
<br />.
<br />r :•.
<br />f
<br />
<br />~;
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT ... - .,
<br />".
<br />:
<br />.~- , ... .,
<br /> REQUI_REM_ENT ._ _..~ ._
<br />__.
<br />. ._.. ~
<br />NAME(TITLE PRINCIPAL EXECUTNE OFFICER l Ceniy antler penalty of law Nat Nis tlocument antl all attachments were
<br />i
<br />i
<br />tl TELEPHONE DATE
<br />_
<br />'~~
<br />fj [
<br />'/t
<br />? S -~
<br />°l ~ "~ th a system tles
<br />gne
<br />prepared antler my tlirection or supervision in acmrtlarxe w
<br />to assure That qualifietl personnel properly gaNer antl evaluate Me mbrmation
<br />~ ~ ~
<br />* .
<br />/
<br />t
<br /> submitted. 9asetl on my inqu4y of the pemon a persons who rnarage the system,
<br />~
<br />~ or those persons tl~recgy responslGle for gathering the inlormation
<br />the information -
<br />
<br />~
<br />~ ,
<br />t
<br />owl
<br />ntl b
<br />lief
<br />tore
<br />accurate
<br />ntl com
<br />lete
<br />itt
<br />d l
<br />t
<br />th
<br />b
<br />f
<br />k
<br />d
<br />b ]
<br />~ J _
<br />~ ~
<br />~~
<br />%
<br />~- ,
<br />~ >
<br />, , ~ ge a
<br />,
<br />,
<br />, a
<br />p
<br />.
<br />m
<br />a ,
<br />o
<br />es
<br />o
<br />my
<br />n
<br />e
<br />e
<br />su
<br />e
<br />e
<br />i
<br />iM
<br />i
<br />l
<br />i SIGNATURE OF PRINCIPAL EXECUTNE ! S
<br />.
<br />, G, i J -; ~
<br />
<br />TYPED 6R PRINTED I am aware that (here ere significant penalties br subm
<br />tt
<br />ng
<br />ake
<br />Ortnel
<br />on,
<br />indutlin the ossibiA of tine and i isonmaM for knowin violations. OFFICER OR AUTHORRED AGENT
<br />p
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
<br />.. ~. . =9''A[. n'. 20": .,.. ., S° .. .: .'~ - Pi_• .'TEL! -., ..t , i' ... .- . ~ _.
<br />EPA Form 3320-7 (REY 3/99) Previous editions may be used. n O ~ i j ~ `, , ,; ,. L THIS IS A 4-PART FORM PAGE OF
<br />1
<br />
|