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PERMITTEE NAME/ADDRESS /l!1[hldt• NOTIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES 1 <br />I-atilip ~1'ame/Loruliou il' Ai!(erenN ---~ 11// DISCHARGE MONITORING REPORT ! DJ1R/ <br />NAME nom. - ~.. ., .. n- C ir~ '~). CP-- /?-Ib) l17-191 <br />ADDRESS •I ~_ ":.-K " T r_; nn,~'~ ~ I' ~~ rc Hance Nur. <br />_ _ - 1 II T n ~ -' T r- ' ' v . ~ 11 I l~. ~! 1 ILr't~ ,/ st~Z ~J ~ PERMIT NUMBER o s e[R <br />FgcILITY MONITORING PERIOD <br />-------/--------------- YEAR MO DAY YEAR MO DAY <br />LOCATION ~~^-.L1Jg~.yyT-G-~~.,.~~~~~~- FROM ~ irs I.1 TO - <br />4TT•IL q,r~: rY-".~ ~.11.•'t ~v ^rs r'T I, ~.r ., r7n-zl1 r)1-~ <br />tl r?4-?il r76a71 r7.c-+u1 nn-In <br />•. rIrTC ACT ^F~:^TVi °7{ ^n, A . <br />(° " .1 •~ •- ~ ! Form Approved. ~ ~ Z •' <br />- ^? +: A T OMB No. 2040.0004 <br />• •• T ~ Approval expires 1031-94 <br />NOTE: Read instructions before comDletina this form. <br /> (J Card On/rl QUANTITY OR LOADING (4 Card Onle1 QUALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(46-SJ/ (5461) <br />(JS-0J) (Q6~SJ) (54-6/) <br />NO. FREQUENCY <br />oR <br />SAMPLE <br /> <br />(JJ X71 EX <br />nNwLYSs TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />t.-•°. I• ._,r0 „_r ". 4 r.. .': ]I-') Y: fIY: rYw: >ti !rrtait (: f:': f:': ~-: ...: ~. /f .. ~ ~ <br />~ <br />,. -~InnA^• •:*A SAMPLE <br />MEASUREMENT >'oO Q Q'M{I Grpb <br /> PEP.MIT <br />' ff. 17~p, {f Sk R14Yhi r} h{,c{:.fQ+f ^D- ~ TRL's l i~~~.. <br />~.• T ~ • -. ~,[ P ; I-' REQUIREMENT ` rj:} ~ K `~ ~!2 1 '. u T <br />~•, <br />, .1~~• SAMPLE ': ~:`, {r't': ..., .; is r]:: C: I: ': I;: i. .-L....:, ~ ~.~) <br />w n y ', ' MEASUREMENT ~ S <br />O <br />O O (LL,, <br />T e <br />` <br />C a(~ <br />V <br />~A ~ 1 'I PERMIT ~: ~)}{4 {z:~ {F {t~¢~(r I:: {: :. e <br />f <br />~n <br />~p!'~I•ti $~{f A:.sf {t i4i ~r~L•t t,'i~:. C~- rrV <br />T <br />'n ~ <br />~.1 ;.. .1 _. .. ..r. '.'1 ;'~ VbT.'1-: REQUIREMENT :kteC?: h~ y~~U~ 1''4'1:T .. <br /> SAMPLE <br /> MEASUREMENT <br /> eL <br /> <br /> PERMIT <br />REQUIREMENT 4 #~;:' <br />~zbfi <br />. • <br /> d <br /> SAMPLE ,~ <br /> MEASUREMENT <br /> PERMIT <br />7. <br /> REQUIREMENT .. <br />: ~ <br />'.:': - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQVIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ -~ <br /> REQUIREMENT _ _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY oR LAw TMgT I HgvE PERSONALLY ExAMNED <br />ND qM FAMILI <br />R WI <br />H <br />F <br />MPTIQV S <br />BMITT <br />N <br />A <br />BASED <br />D TELEPHONE D A T E <br />r / <br />Y A <br />A <br />IiEREI <br />. <br />T <br />THE IN <br />OR <br />U <br />E <br />NO <br />ON MY INQUIRY OF TIiOSE WOIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />ORTgIMNG THE INFORMATION I BELIEVE THE SUBMITTED INFORMATIQV IS <br />v <br />~L • IV{ `/ U~ TRUE gCCUFATE ANO COMPLETE I AM AWARE TIigT THERE ORE <br />GNIFICANT PENALTIES FOR S <br />MITTING FALSE INFORMATON INCLUDING I <br />~ <br />n Y <br />1 <br />( <br />G <br />~ ~ SI <br />UB <br />THE PO551BIL1TV OF FINE AND IMPRISONMENT sEE +B USC 5 1001 ArvD 3i' 3 '-~a <br />goy I Gr 0'1 ~ n <br />IY 4 { <br />7 <br />h L / G \ 33 USC 4 1319 (PMJI(1e5 und(r Ihcs[ sldlulfs Irldy ipChl df ImC! Y <br />1 (O SI NATURE PRINCIPAL EXECUTI E _ S <br />TYPED OR PRINTED r <br />510000 and or msllmum 1mPrisnnmcm of bn.efn E monrhs and 5 years.) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> CO E <br />COMMENT AND EXPLANATION OF ANT VIOLATIONS (Relerenef all alla[hmenti here) <br />.aE ^1~~ - I•~.~~) °"~. ^.T1. •- ~r T^o- c,+/•o•..o ['~ ::~:r1n^ tr•S' - •.m7 ^I amTr-~r nr~..~n ~_-, ,.._ P ,- <br />- iT p <br />-A• .~+ ~. ., ;~'^yN'S~i, r.j r. ATm A(•R ~ '1 ~:L .,)Y I^S'"Y ~:: 9r'?).. ^n .v ?fl .^,M'. •-c- - lc 1L' <br />.,. - <br />^ <br />f <br />Form 3320-t (Rev. 9'881 PlOVi01I5 2dl(IOrIS may bE used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 ^ e, I PAGE OF <br />