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PERMITTEE NAME/ADDRESS /lndude FaciGrv Name/Lorannn l Dl erem Form Approved. ~ ,~ <br />NAME I fl ! NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM1 (NPDES) <br />5 t 11 F, C A C C A L C C C F A Y Y DISCHARIGE MONITORING REPORT (DMR15) r L i U n OMB No. 2040-0004 <br />ADDRESSUHAM ER D C~ C] la. I )~Ub1i EY) APProval expires 05-31-98rjs~ <br />tlh TDtN ~ .. CO EILb.iV TNUMBER, DISCHARGENUMBER F tIill II CL~7I <br />FACILITY MONIT INGPERIOD ACU~'E -E7 ZES]I!G ECta CLQA <br />LOCATIO - ~ YEAR MO DAY ~ YEAR MO DAY ~r Y ~ ~ <br />~fA7DE- IbIO FROM .TO v d ~ '~~~'~, Q LIS.CNAAGE IA1 <br />.1 T T N : L • b U D e EI O Y fl , G E B E H1 L ~ E R (zo-zn rzz"za/ /z (zs zr) (zs-zs! (soap NPT~.,~ead Instructions betor completing this (orm. <br /> Only) QUANTITY OR LOADING ""d Card Only) QUANTITY OR CONCEN N EO. FRED FENC STMPE E <br />PARAMETER .(a-- 3) (64-67) (3H-46J (46-63) <br />(32-37) AVE~ ~w~~GE <br />~P^ MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(b`2-631 ANALYSts <br />(6d~6B) <br />6970 <br />" ~ ATFE: 4bli;? f.Cli SAMPLE pt0>,/78A 00:/C~t>D "'~'<" i i3) <br />CtHIODkPtlMId MEASUREMENT <br />f AFl3it 1 U G .~ <br />PERMIT A0~1 II Y. ',~ .Q ~ + j~- ` ti4,~ ~ ;~~ .". <br />eFFLUEnT GIiU55 VALUE . <br />REOUIFiEMENT <br />, ~ `y <br />r)•j I E1T , <br /> ~. ; <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> 'kERMIT a'„-~ ~3" t 5 <br />,": ~~I 'L_, <br /> .FE4UlI~EM~,NT ; ,,, i , .. f <br />~ ~ mom. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> .'REElU)pEME ~~ Fr ": - . ,. . ~"= ,:v. . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> }~EQk11R~Ml=NT, ~ - -.'E r.~` j <br /> SAMPLE <br /> MEASUREMENT <br /> =-#CflMli.- - ~ -. - "- <br /> (iEdUIE'iEM~NT <br />' <br />; "' <br />s e <br />„ <br />, <br /> , - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> tiEQ'il[iEr~ENt; ? ~`' ,~ ': <br />. r ~ ~;< , <br /> t . ~ <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EXAMINED AND ~ TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HEREIN. AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING / <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, G <br />~ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT _` I ( <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE ~ <br />U ~ ( b <br /> POSSIBILITY OF FlNE AND IMPRISONMENT. SEE le U.S C 5 1(Nlt AND 33 U.S.C. SIGNATURE OF PR CIPAL E7(ECUTIVE <br /> s( as up to Ero.ooo entl pr <br />na <br />mpm <br />~ <br />e <br />u <br />~ <br />m <br />B <br />u <br />t~p <br />~ <br />e NORIZED AGENT <br />OFFICER OR A A NUMBER YEAR MO DAY <br />TYPED OR PRINTED tl <br />is <br />ntl 5 <br />y <br />aer <br />eu <br />i <br />m <br />nsonme <br />lbeMe <br />e <br />6 r E <br />GUMMEN I S ANU tXYLANA I IUN Uh ANT V I VLA I I V rvJ (HereTBnce au anacnments nere) <br />StE PART I.A. FCd CETAILS OF LEST PROCEDU6F. HFiCBT L04EST CILL'T1C6 (A EFFLUEk7) 4HLCE 15 LETHAL IC Su: <br />CF TEST ORGANISttiS (LC50) AND ATTACr ACUTE TCIICITI TEST REFCNT FGfit TC CM F. <br />EPA Form 3320-1 (08-95) Previous editions ma not be used. REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />