Laserfiche WebLink
PERMITTEE NAME/ADDRESS llnelude <br />Fariliry' A'amr/Loralion if diflerenN _ o , I <br />NAME _ _ _ - _ _ 1 . r- t4_~t.]Ji~ t_ - <br />ADDRESS!_C a _I. Y _Y I !: L _ _ _ -f p ~ _ 1~_~ <br />FACILITY <br />LOCATION ~_L,-~1.~ _~Li a1• "1 ~i ___ <br />NATIONAL POLLUTANT OISCHA RGE ELIMINATION SYSTEM (NUDES <br />DISCHARGE MONITORING REPORT (DA1R) <br />I,.IAI (l7-lv,l <br />!fin%T1 UI.'F`~' 7~1 a <br />PERMIT NUMBER mscn.PCC rvo:+arP <br />~~ll MONITORING ISI~IOD <br />YEAR MO DAY YEAR MO DAY <br />FROM I I V TO j <br />(?0 ~?2-'rl (N-?5) (lA-?7J (?3-?41 ) ?0-111 <br />p 7 p c r) Form Approved. ?~~ q <br />r - c . N ~' OMB No. 2040-0004 <br />T ..~ ^ D Approval expires 10-31-94 <br />NOTE: Read instructions before completing this form. <br /> (J Card Only) QUANTITY OR LOA (4 Card Only) QUALITY OR CONCENTRATION <br />EPEOUENCY <br />PARAMETER 1465.1) (54-All (rd-4+) (46-71 l54-611 NO. <br />E% ~ SAMPLE <br />TYPE <br />( tl _77) ArJgLrsS <br /> AVERAGE MAXIMUM V 6YiS MINIMUM AVERAGE MA%IMUM UNITS (h o~ll lAJfixJ 164701 <br />' SAMPLE ... <br />~ h/,=:¢.',:{:' - ( ~ i <br /> MEASUREMENT 1 . 7 <br />! r l O 1 /~ 6 <br />' b <br />g :~'.O>a~A4tt{: 4 <br />0 °rRLT :~qp <br /> PEP.MIT i ~ <br />r~LIJ=:':T "-'.t5; YL.LIIZ REQUIREMENT ^,^ _ <br />!12~tEt~d ~" ? <br />niz, yn!1 <br />'"'TIL <br />77.I~S n..._,.,a... •4'!:Y,:',=$'. ( t.,) <br />r <br />.,'= D C )i n ~- 1 SAMPLE <br />MEASUREMENT < S G S Q ~ /3 ~ G <br />r j - 1 y. (. f,+tt /Y'. w:k!4i': F. jl # <br />~~ ~ <br />e <br />A~x <br />i; •' <br />~ ~ N4•r.~ h • r• <br />'L~P~J, IrwT ;Ulrj° Vi(.•)c PERMIT <br />REQUIREMENT Y: ..±y:,', - <br />QIeTt~ A~ '. g <br />,-~:?~~~ AVG ~x 7D At< 9~JI. M,'1VTk <br />y <br />. <br />~ll J~T74Lf Y UIS.°'?LYn SAMPLE <br />MEASUREMENT <br />DIDO~ <br />rOO~ <br />OrOQ~ <br />1 30 ~9 <br />6R <br />'~~ 31 '. t !1 ~. rf#v?Q~ ##"`. ~!# ... ; <br />P^'IONAL NAL fl <br />31 N!'r/ A?: <br /> PERMIT . • <br />''FL'IV••"!~ 'R')5 YALII-' REQUIREMENT .. Np(',Q ;Y6~ "t AYr, DAILY `tR ''~:~' ^~.,Tp <br />~~T ~"/(? '. '.r{5E .. .. y4Q#h^: t 1 1) <br /> SAMPLE <br />MEASUREMENT ~~ O ~/3V GR <br />.55,1) t n n ##Ut`•rF" ##;4:!:.',:# 4 :r ..: C!4=y:,t:S:4 ~~ 1; ' <br />~ 7N"IN aA' <br /> <br />'.rpill'y]' (, ~O$rj Yp Lll? PERMIT <br />REQUIREMENT <br />. <br />~ _ <br />~ ~ ''`fi AX ~(,/L !yP\!T <br /> <br /> <br />+-L.I '7.a lVL`'NF `(11Py SAMPLE <br />MEASUREMENT 'Y <br /><O.vOZ <br />.G OIOO2 <br />GO•Up2 <br />Q / <br />)130 <br />62 <br />a, f,-. ~ , , 0 ,rr . IYJ:+ 0.. IO+~F ~P°IOMAL .1 y^1•/ ~a~ <br /> PERMIT .. <br />••t'I'sl "'.ll$$ V1T1);' REQUIREMENT ..... .JL't'R ~.V:r ~7DII AY^ DAILI RR .•'=/I. `1~MTN <br /> <br /> SAMPLE <br />MEASUREMENT <br /><Or OOI <br />~ ilrQQi <br />~Q, Q02 <br />O / <br />1(30 1J <br />~^ <br />l~l- "{.J i ~ .~ ##9O $'.` #O'/xRf.:# 4` •'.`:'~': :.)j•^I:7NA1 R•~~1 CPT7~NpC ' 1tC F./ R4'•a <br /> PERMIT . <br />('1`1 rl'I:^ ply` YAL7' ~ REQUIREMENT (}NT"{ iY: 7'1 :1A AV= DFIi,y M1( '+~;/T, MONT.f1 <br />,1:~ T^ ~'.)'lDU~' ~~ SAMPLE ( ~) .. v:'': ., .. .: <br />~~ V - t! : ° r: ~ °': 4 T O { ~ ~' ^' MEASUREMENT C <br />Or OO S~{ D 1 O I IG O I I7 TIV J I <br />~~~.~ 1 '1 1 • <br />U <br />'~ RQAn T #4{s # tr ".# of ~ °RLY as^~v <br /> PERMIT .. <br />. .. <br />:•rf`1 r!c`'( ~C,)SS V.Aj,'I.' REQUIREMENT ~!!OA AV4` 'DJlTi.T RX • ;.• ' <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF Low THAT I NAVE PERSONALLY E3AMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> <br />R <br />1 <br />p <br />r ON MV INQUIRY OF THOSE INDIVIDUALS IMMEDIPTELV RESPONSIBLE FOR <br />I BELIEVE THE sIJBMITTED INFORMATION IS <br />OBTAINING THE INFORMATION / - <br />~ <br />, - <br />t r <br />~ . <br />AWARE TNAT THERE ARE <br />T <br />R <br />T <br />TE I A <br />D C ``~ <br /> g <br />RUE ACGU <br />E PN <br />OMPLE <br />M <br /> <br />M h K N Y SIGNIFICANT PENALTIES FOR SUBMITTRJG FNLSE INFORMgTIOIJ INCLUDING <br />THE ROSSIBIUiY OF FlNS AND IMPRISONMENT SEE IB uSC 6 IWI AND <br />51 NATURE FPRINCIPAL EXE UTIVE /, q <br />}IZ. <br />7-^771'1 G <br />1 <br />0 <br />O <br /> <br />TY ED OR PRINTED 33 use 4 1319. IPrn~lurs under rhar smlmes mel incluJr Oncs up rr <br />(10000 ~uJ m mvsimum JmorisnnmeM rf Aeu'een A months anJ ! )rars.l <br />OFFICER OR AUTHORIZED AGENT AREA <br />CO E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (Rekren¢ all auarhmenrs hole) <br />1~ 1^ r ..: .7n.-~, .1x TN, ~yy1t4L'Y r~r , '•r 1/tA rl/f"~ t{cgltL C ~~'' 9'"? Ln T:•q. {1p! ~i7/ ~ %T "'.{ 7~•~ <br />,;.. "D-J.''. '1a P° 1~-1? '~F9F S6H~L°. AN:"/°'- F~? :~~!. `' S3F.ASF RF'1i17~'"' I° YT°T`'1.~. ,!cry Tg .~Revpr;e~ <br />'Cl^ t_^ cT VT' rrT r_' e T rn T C - <br />EPA orm 3320-1 (Rev. 9-88) Previous eddions ma t~ used. (REPLACES EPA FORM T-q0 WHICH MAY NOT BE USED.1 PAGE OF <br />Y 00"32/95•Qh:3-1.743 ? <br />