|
I :,
<br />I. cc n,:I.¢InJJnuid rl,~~i,[4rrynaw/LOCarlan lf}lldlnnr)
<br />NAME
<br />ADDRESS ,
<br />.. !
<br />FACILITY ~. _ - _ _
<br />LocAnoN
<br />NATIONAL POLLUTMT DISCHMBE LLiriiNl.Th7N b1'S:!'. 7.4~n_1_E$I ~ ~ ~ I '• •
<br />DISCHARGE MONITORING REPORT (DMRI „ 1 „ , 1 ...., 1 ~ HOMO hJJ rt.. -.L'.i I(IOr!1. R
<br />7-J 61 17-f91
<br />1 1 i 1 ., : ~ ^ ~ • -( , ~ Approval pzpvee OS-31-58
<br />PERMIT NUMBER DISCHMGE NUMBER , _ - 1 , i i l
<br />` MONITORING PERIOD '
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ / " ~ TO - - ~ - ~ I -- I ..
<br />r9mn nzza vi.asl Haan nw-am /an9n NOTE:R.ed hetructlefp Mloo bomDtetlna this form.
<br />PARAMETER I3 G.d owlyl QUANTITY OR LOADING !~G/d OnAd QUANTITY OR CONCENTRATION NO. FREDUENCV SAMPLE
<br />7 M663 /5461 138-151 r~6-63 BFBr OF
<br />!~ 3
<br />1 EX
<br />Ss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /s7-691 MALV
<br />/µ5B! /6&701
<br /> SAMPLE .. .. ( ~ 1
<br /> MEASUREMENT
<br />.. I, ~ PERMIT , -, „ '; t: ::'(s'r. L: ?~ -
<br />c' 4'-. ::_:~ ..
<br />'~ • ~". . ` ~~ -.
<br />(. ~
<br />~ :. 1. < ., ,I
<br />.. ,
<br /> REQUIREMENT . .
<br />
<br />
<br />~ SAMPLE ~~-,
<br /> MEASUREMENT
<br />•
<br />,, .~
<br />.. L ., ~:PERMI7-~~
<br />~ ~ ... ~~:-;~~ •aG#.,Y`n+P..` 'C ~_.~: rr4 i{::RM S'I.: ~C>~. ~Sf' ~' ~II: ~/ :i~lt c.
<br />1 ;. ,, T .~ 1 , 1 EQUIREMENT
<br />~ ~ ~ .. .
<br />.~ ..) ., i l : r _i i'' i, . .. .: ~: SAMPLE .....y .. ;,: •: ,::;t ~ :;: •: t ..
<br />~~
<br /> MEASUREMENT
<br />1 ~ ; PERMIT ;+.... , =: ?I:~... :r-.. xfi~.
<br />'`' l t
<br />i'. ~!kAt.
<br />~
<br />.~~.:~. _.
<br />~
<br />~~uCF,/
<br />' ~.:b; L:Y.)
<br />
<br />
<br />~~- ..REQUIREMENT ~ ?
<br />.
<br />~, , i I
<br />-a
<br />..~ r
<br />~. / . s
<br />1.'
<br />a~
<br />?'1%~IAL
<br />~ SAMPLE r: c .. ( ~)
<br />(A:i ~. MEASUREMENT
<br />. _ ~ ? C PERMIT , ';: t::;: ;: :: ~'F ni c e•< `. :: ,'s' : ,.:; ~~. t . 3.. ; - : /
<br />~" 1, .
<br />- ` ~ ~ .;
<br />- .. 71EQUIREMENT ~ ~ ~ ~
<br />,I a ~ ~ SAMPLE ~ . ~:: :: -:~ r,. ~ :: ~ : ': ;:- .. .. ,, ,.:. ( ~ 1
<br /> MEASUREMENT
<br />.., .. i • ;' :PERMIT , ..... - .. '~ ",a,'Y.::: - . l.`.i:~ y: ~;: r: ~ ~ ~::::'.".:~.:` t?.~ . -
<br />~:
<br />~~ r _ 1 "; ^ , ~., q
<br />_ V I. L i .REQUIREMENT S' +2 :/r
<br />`, !Ci 4.7C i'!' ,I SAMPLE ( J.T. ., .
<br />qpr ~ Ft
<br />~ MEASUREMENT
<br />.,
<br />_ t; PERMIT .. !~:;' :3F:P?r'T ... x~CI. ~ .. ... •:sc: N; .
<br />'
<br />;"
<br />' F .. ~ , r -I C ~.
<br />r iiEQUIREMENT
<br />J ~~ a , y ^ 1?. 1 L.Y "i[ ... ,
<br />,
<br />i.i-. ~
<br />i )T?L. SAMPLE ;: is ::.: - 1 ( 1'1)
<br />. -, ~ ~/ / MEASUREMENT I ~I, ~ ~ ~ , C,
<br />~.:!_ ~. i PERMIT :M':.+"-;: trY =a Y~~, :?.`.'^'.:a ,'?-f+.~" "J i'°`i,.l
<br />i L
<br />~' r' L .... . h r);-• .; REQUIREMENT ~ ~ ;: -.., .
<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFlCER I CERTI
<br />AM FA FY UNDER PENALTY OF UW THAT 1 HAVE PERSONALLY E%AMINED AND
<br />MILIM WITH THE INFORMATION SWMITTED HERDN
<br />MO BASfD ON TELEPHONE DATE
<br />
<br />(, ~ I t h "- C b [ /~ ;
<br />MY INOIRRY OF TH05F INDINDUALS IMMEDIATELY RE~ONSIBLE FOP :
<br />~ ,
<br /> OBTAINING THE INFORMATION, 1 BELEVE THE SUBMITTED INFORMATON 15 .
<br />~
<br />
<br />[
<br />-
<br />. ~ ~ ~.+
<br />( TRUE, ACCUMTE MD COMPLETE. 1 AM AWMF THAT THERE ME
<br />SIGNIFICANT PENALTIES FOA SWMITTINO FALSE INFOMIATION
<br />INCLUDING ~ ' . , `/
<br />,' ;/, ,
<br />~
<br />,;
<br />_
<br />~ ,
<br />THE POSSINLITY OF RNE MD IMPWSONMENT. SEE IB U.S.C. 1 1001 AND 93
<br />u
<br />c
<br />1 1 ala
<br />s
<br />rFrlrnF..
<br />le,r a
<br />,. mart
<br />i
<br />l
<br />Y A
<br />t fD
<br />DDO _
<br />
<br />610NATURE OF PMNCIPAI EXECV7IVE
<br />J),'/
<br />~ ' - ~ / ; , -
<br />j '"
<br />!.,
<br />TYPED OR PRINTED .
<br />.
<br />.
<br />.
<br />ra
<br />r
<br />.
<br />.. mry
<br />c
<br />r, rp m
<br />,
<br />.na>,RU1.+wI:RA.n.Iwl.,rws.n..r,sma,wwewu OFFlCER OR AUTHORIZED AGENT ACppE NUMBER YEAR MO DAY
<br />V V~.n.I~I.IJ /11vV ~~I rI.I.I.IIVI. Vr I.I.• ••V~,i IIVI.,a InOI V/vln:0 NI OIIOVIIIIIOIIy IIOIO/
<br />/ -
<br />I
<br />"r r
<br />~ I '!
<br />EPA Form 3320-1 LOB- Pfevioua edrtiom may be ue - 1 LACES FPA F M T40 W C MAY OT BE US D.Ir _. PAGE OF
<br />
|