|
PERMDTEE NAME/ADDRESS (Include Faciliry Name/Locarion /Dif/errnq
<br />NAME
<br />RO.Ir: ii :,:Gkr''.~. CL"IS'':f,
<br />ADDRESS LiO+[6 •. 1. !
<br />FACILITY P A U ti 7 A C O '11 G 23
<br />LACATION
<br />:TOM [ ' CO dl q 2'i
<br />ATf~: wILLGf" 4. -,;'aL 1 N, nIYE MGR
<br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />(2-rel fn- e)
<br />r•-,n~
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 9 7 ~ 7 D TO '7 ° ~ 9 !+
<br />(20.21) R2-231 R0~251 RB~211 (28-?0) (30r~1)
<br />Form Approvetl.
<br />OMB No. 2040-0004
<br />I ~ ~ ? Approval expires 05-31-g$
<br />(`i rka~ VL r)
<br />:sCRG OP sa Tp D~.f.R TPA71.. ':"r.N
<br />A yNOTEi Read Instructions befor leting this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Cold Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 46-53J (54-61) 38-45) (4853/ (5461) ~( OF TYPE
<br />(32)7) -AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANUVS/3
<br />6&70
<br /> (B2G31 (64-s8
<br />k'H SAMPLE - #fi^.GO+ t#;,: •::~Z
<br /> MEASUREMENT
<br />U U 4 U 0 1 C J `PE`)ihll~` .`'1pi(<t~V¢~t ~ }-:~ 9#C ,~~ i,~, , ""_ ~a=: -
<br />~ ~ '
<br />~FYLUEr+T
<br />'r^`;G YALU HEOU)REMENT; .'~
<br />Y ~~~ #L2# ~ ~ ~
<br />' ~ ,F
<br />, .
<br />.
<br />' , .
<br />IDS, TC°. AL SAMPLE ###R## G4##3~k ######
<br />( 1 9)
<br />S P E N D c u MEASUREMENT _
<br /> ~ .
<br />~ ji:~l~
<br />-;FFLUEN'1' GP035 4ALU h t'i`v?I; - }~~
<br />iNi ~t-
<br />+~w* y?;## f -r~~ `t
<br />+ r M,
<br />( ~~
<br />:,Jk.IDS, SETTLEA9L6 SAMPLE 'h;:'<##"+~ 4~'A~Gr~ ~?###";= ( 2S)
<br /> MEASUREMENT
<br />U,r~41 1 0 D IT ~+tm##,#.~0' '..,' '##
<br />r ^.:;: ~ O4nr0## ~.. .;-: bA2"' .' +~ -..,; ;~ ~:. 0 "'`'; ~ .
<br />rLUENT GR05S YALO. R EMENT ~ ` at#
<br />.
<br />mx, - ,~ ~,,:
<br />L nL]h:, TO~?AL SAMPLE
<br />MEASU
<br />ENT %~h#
<br />~ ~. r~r, rr,..
<br />l ,. 'k
<br />~ ~ ~ ( 19)
<br />(A S r C) ' ~ REM ~
<br />~_~ l iil~ S I 0 0 Rfa`iiMIT 3aR+Pl$04 ~
<br />' ': r,. yl #~
<br />3.0
<br />':
<br />~ `_
<br />...
<br />NC''g ~ ~~
<br />~g
<br />~+~
<br />..I•'FLUEhT GROSS YAL~! REQUj,EMENT - - ..
<br />~; #-;..# :.::;-. , ~ %
<br />7LL AND GktEASE SAMPLE ~"~.`-{r.y#0'k '3##4## ####:`L: ##.-#'s'`- ( 19)
<br /> MEASUREMENT ~ r
<br />~ssd2 1 D o `;PBAMIt`r I a ~ ~ ~
<br />
<br />~ #~# ,~ ~, # ~ ; ~~„ - ~ , ~.~
<br />'
<br />I:FeLUENT GROSS YgLUf IIAA
<br />~RE4U EMF,N? p" ~,,° ##G2 - .' p^ .^ ~
<br />t' ~, IM CONDUIT Op SAMPLE ~ ( p3) tt=-a#3 "-~(#rt:- ,gtq;;v#
<br />,~U TREATMENT 'L~" MEASUREMENT ~
<br />SUUSO 1 0 D PERMIT ;'SEP~! $~f'd~;'~. ~OA~> '~Or4 ~Oupli?Ocitf #~.~ ~'
<br />xs~cZ•
<br />"
<br />EFPL06D1T GRO55 vALU -REdUTAEh~NT -.~
<br />. r e•_ .. r. 4.., ~,'...
<br />:;ULIDS, T01'AL SAMPLE aaca#a ?sY~:z^ ~,.~.~°^ ` ( 19)
<br />UL~SULYED MEASUREMENT a
<br />70291 1 0 U -PERMIT 3f##~# ~~0*At~IrU~ ~ ##:; :~M>##. _~ R'~ ~"(`YQ'~~i~
<br />~ -',` T~l"~, $" ~,
<br />c:FFLUENY GROSS 7 fl AEGfUIhEMEN'~'' a ###'l + , ,
<br />"`=
<br />NAME/TRLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY U DER PENALTY OF
<br />AM FAMIDAR WRH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br />
<br />
<br />J INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON
<br />E THE SUBMITTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE, '
<br />i "'
<br />/
<br />/ ACCURATE AND COMPLETE I AM AWARE THgi TH ERE ARE SIGNIFICAM ///
<br />/
<br />J
<br />/ ~ L - .
<br />PENALTIES FOR SUBMITTIN G FALSE INFORMATIO N
<br />INCLUDING THE ,
<br />"'
<br />/ '1
<br />~
<br />I ~ / i/~ /I l y ~~C r1 ~/ ~
<br />POSSIBILITY OF FINE AND IMPR
<br />p ,
<br />ISONMENT. SEE 18 U.S.C. § 1pp1 AND 33 U.5 C.
<br />Il
<br />M
<br />tl
<br />0
<br />000
<br />3
<br />SIGNATURE OF PRINCIPAL EXECUTNE
<br />~~ n \
<br />y°~' ~~ ~
<br />7 `1
<br />/U ll
<br />d i
<br />TYPED OR PRINTED rrev up ro
<br />e
<br />1
<br />,
<br />v
<br />or
<br />it o/beMSenNB m4onW entl6u
<br />mum Imp smma
<br />revs.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIULAf TUNS (HelerenCe alr ettaCDmenLS Here)
<br />~E4TLEAULE SOLIDS S.Il2T APPLIES P.NLY IF C=102P,24P,d PR5'CI? ?YZVT IS CLAIfSRU. IF CIe.IM APPFCYBD FY iIpCD,
<br />:SS & IKON LT'ITS PILL NOT ?E APPL.I9D C1 RP,PORT`:D NEASU4!?0F!i'"S-:;gr I.A.2, P, S PO° BURDEN OF PRJOP
<br />~. _
<br />EA ^'Form X0-1 OB= 5) Prevlouse itio s be u9etl.' •`• (iIEP CES AY .) - •'-' • - PAGE OF
<br />00105/990312-1222 1
<br />
|