Laserfiche WebLink
PERMITTEE NAME/ADDRESS /In[Illdr NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ <br />Fntiliry~ N':m1c/ nra(iou i! dillrrem11 <br />~ <br />~ <br />K <br />~ DISCHARGE MONITORING REPORT / DMRI <br />~ Illbl ~•¢ <br />NAME _~F <br />-- <br />-- <br />--- 5( <br />e <br />---- w.re <br />_--- <br />(J./6) <br />fI7-19) <br />1. <br />•- <br />ADDRESS~._: l T <br />~ 4 ~ ~4~ J. UTS~C/ •! I27O M <br />_ <br />---- <br />-J-_ PER <br />IT NUMBER <br />ozce <br />~ .R <br /> <br />-------- - ~-- - <br /> <br />FACILITY MO NITOR ING PERI OD <br />S <br />C <br />y YEAR MO DAY YEAR MO DAT <br />LOCATION <br />~ .ti5 <br />a u <br />____ ~~'_J- G t •Y Q r <br />___ aI lwnw,/~ FROM <br />/ <br />F ) TO <br />~~ r; ron.n~ .n_i.~ _.~ <br />~" "! ~ f 1 Form Approved. ! ' ~ : - <br />- o T ~~ ,M1 ~ OMB No. 2040-0004 <br />~,: Approval expires 10-31-94 ' <br />Nf1TF• RnnH inefrllr}inne NAfnrA rmm~lAfinn fFie fnrm <br /> (J Card Only) CUANTITY OR LOADING ({ Card Onl v/ CUALITT OR CONCENTRATION <br />PARAMETER ({b-SJ/ (J{-6/J (J8-{c) (ab-JJ) (5{-6U NO. PREOOUF rvCV SAMPLE <br />( li-.71 EX aNgLV5i5 TYPE <br /> AVERAGE MA %IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> (b:b/~ (64-63) (69-10) <br />JLL qcc r' -rE <br />' <br />SAMPLE ...,•_rt~sr <br />_ <br />O ~ '.,1) h..,~,, ...: +: n:+,'r:•:-: -~(I;:^r:: <br />WKI <br /> <br />~1 <br />~; :: 7r <br />MEASUREMENT O y V 5s <br /> 1 <br /> <br />11 ,1 .'1 f~ri ~ '.I <br />PEPMIT <br />X13 fiQ:~'" .n <br />~ ~'P~CQ4 <br />i~ -~ <br />~S~+kQif :k <br />R5~1~'3'F#i: s tv• <br />8'~C L.~' y <br />t L'4~{T, <br />rDl /^`: +` ~ -' Y.M1 _ RECUIREMENT ~Kc1w !AAK ..l_r} <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> RECUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> RECUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> RECUIREMENT •- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> RECUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i CERTIFY UNDER PENALTY aF Law THAT I HAVE RERSONquv Ex AMINED TELEPHONE DAT E <br /> 4ND qM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASEU <br />S. M ~ C U~ r ON MY INQUIRY OF THOSE INONIDUgLS IMMEDIATELY RESrON510LE FOR <br />OBTAINING Tn'E INFORMATION I BELIEVE THE SURMi1TEO INFORMATION IS /~ ) ~ <br />~ <br />` <br />/ <br /> <br />M <br />~ <br />, <br />~ <br />- <br />` <br />TRUE ACCURATE 4ND COMPLETE. i AM AWgRE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FgLSE WFORMPTION INCLUDING ~ <br />I< <br />` <br /> <br />3(/i -,7U <br />9 <br />1 <br /> <br />" <br />N+ <br />-/ <br />jt NQ1fG <br />~N~ <br />~ <br />r- <br />THE POSSBILITV OF FINE AND IMRR150NMENT SEE le use 5 iaoi qND <br />33 USC 4 1319 fPrmin <br />d <br />th <br />l <br />d <br />r <br />SI ATUREO PRINCIPAL EXECUTI E - <br />u4 ys~ ~ <br />~ <br />I <br /> <br />TYPED OR PRINTED rs un <br />er <br />ese sluNlrS may mr <br />u <br />r <br />mes u~1 m <br />110000 and or maximum 1mOrisnnmcm rI brluren 6 momhs and 5 ycarsJ <br />OFFICER OR AUTHORIZED AGENT <br />A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> COD <br />'S~.iSi1 ~.'.-1t... ~TTi. .'1~-~. `. 1.•.-...Tn •rrl°i •'4,!i~r•/frV ,_ 'V ~'l~~.A rl. ~y ~~ O^_rr+^ f1' .. ,~ .~~.i -, T. <br />l-R. 1•.-..'•I:r PF 1'l-1~ ,. T'}~ 4'n"~"..°' '.'I F. T.Y"TS F(Iti Oi! ~ Gd=...ir ur n, qc") ,~r I.. 4. .. __ -1c~T•op '? - <br />c~ n~ V^MT '1• rT c c nnq•s oe^ T • [ e r 1 1. <br />~AForm 3320-1 Rev. 9-88) -revious ~etli(ions may e used (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I <br />/,fin ~-r/r~S ~[~~-~. 7117 PAGE nOF <br />