|
<br />PERMRTEE NAMF/ADDRESS pwdaFrWp R~/Ix.rlw (/DlQwwtl
<br />NAME ~.. .. ;, ~, ,1' ? 'i ~!". .'n ~. _.)°'~ ,
<br />ADDRE55~7 I I. °. . 1 , ,'. ` .1 , G' . .' , ~ r . . ,, I(
<br />FACam
<br />LocATIONJAA .~yl'.`^, ~~ li (`4!:J
<br />v r• 1' 9. '~ E^ 4 S' 1 :1 r, l r ~.. _ .' V R T tl R p" i
<br />NATIONK POLLDTMT DISCNMOE ELIMINATION SY4TEM /NPDESI
<br />DISCHARGE MONITORING REPORT (O Rl
<br />PERMIT NUMBER pSCNMOE NLMxEII
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR 'O DAY
<br />fROM 1 L ) 1 TO
<br />)
<br />F - fI :: }I.
<br />vI.IF 1 r'1 ~i7
<br />.,
<br />
<br />NOTE: Rr.Ad IrwDVetlpr bralorr. eomplraflnp Ihb form.
<br />
<br />PARAMETER QUANTITY OR LOADING
<br />QUd11Gy Or Concentration P1O- EREOUENCY SAMPLE
<br />
<br />EX of
<br /> M'urme TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />i.7 ~-;+. '.. :r'~:ini.LY SAMPLE ^. r. rfaR} t: .::rChct r~d#s4h ( ~)
<br />' MEASUREMENT Gd
<br />~I L ~
<br />['L'I k.
<br />J L
<br />% r L E I
<br />)1 iUA I J Il ;~,~.:..PERMIT:.::-i:~: .•.;.ler~x.n f~:9c!1 "._: -r`:~:~~ar~:Ar.#'+s ~ix ~ .1`-~f*r Xsl~~..:~"°. r",':.R.~~~~"#:R~~f `: ':; ~
<br />.R:E.~~d~~':~`':~:~ k-«,.
<br />i :.;.
<br />r r L U ~ ,: r :: S~ ~ S ~ 4 A I. t: t REOUIREMENT° ~
<br />~ ~ X • k Yr:.~ .
<br />{F € G1! 1<X.: ":: / .. ! --
<br />'loj•=~rr ''~']'"':Ti1LiY SAMPLE 4•'h7~Fh at<n lkan nc~tk k'xt _ . ( ) 7r
<br />
<br />~' i » ~ L.~ .,~ i)
<br />MEASUREMENT ~
<br />~.C~ J. ;~~
<br />L
<br />~' ,Y
<br />J: i')b I U 0 ,f'::~:;.PE•RMIT:...~:: ~.. ~.:'g G-f+OtR!,r.. ,P`+X:: - ~ 1~.3~:~: '~~~'~ 'I~ l~t1` .. .. . ..a L.' .,
<br />f r" L'J °_ > T. .. k ) 5 -i V A L U!' q..EOUIR~MENT: :.:.:. ~. .:!::. ~: ~. ~.r ~...:.: ? `r.~ <_~ :.. ~>: . .y..,:, ,. :. ~ :.?:: ~~ :~ :1fr:. '.:'.}'1.$ €'rL~Y ~.~:.M~.X~~ " C / 1
<br />:n,~"II.", SAMPLE axaz4D ._.>t. r,.t^, •-rt"PF - ( ' ') ~
<br />r
<br />: 1' L !! T L d L L € ^ f '::. 0 i. V 11 MEASUREMENT _
<br />~ ,(' , ~r] ~ G r (~?C, ~1~- / ? ( F-/ ;, ;
<br />IL 1I ~1 1 :) r? :';.;'.:.PERMIT :::.::....: ::.':a.`1-`.11'!d: h.C ~s~;':.: ;?:r'C,R.;fE}d:A:: y v...... :.. GJx ~~~`;I .'~~''.~:p~~:~~'.` ?:::r$1~!.wu
<br />'`'~°':~;'<~;i:::. c, 4... :/ _ .
<br />t rL.l t:'~I :IRJ' ~ ~J ALIJ g .REQUIREMENT. ~. ~ .~;"
<br />~ 4'.': ~ II 'ri, ,
<br />>~.~~::~~ KT:: :/r tir ~?'.;
<br />d Jl: P.a:. :-., SAMPLE .. ~n7 ~T r: rk~r:rt .. ~ .. ..k .. ( :,
<br />'r'nTIALLf (II:: Sr7 L'JJ MEASUREMENT ;,' vi 3v .~75f ~ '{
<br />
<br />~L 111 1 J U
<br />';:;~;~:FERMIT':'.r. .,.::..
<br />rk Ly:~a3.'[:.::~:
<br />::.; :!.C^kaf~4:C: ¢
<br />::'r
<br />::~:'r~~S~.L:'s?`X`•C `:::
<br />~ 'j~.i~`~€S~l':€?::~::
<br />:5::~?~51~`;t':E3a) "' ~:.
<br />~: ';~
<br />`I''n.:T..~~
<br />...,:.i -.
<br />-. ~. - . ~ r, .~ .REQUIREMENT ..
<br />~. ~~::.i:.: ~ ~'~.:...: :.:? .:::... :.., ._,;
<br />.....: r", r
<br />.. 1. ~
<br />r::.~. ;til..,:'~'t'!`
<br />-'IL ?\:` ',q•l F' SAMPLE .. :;<,, -: 4G4•.. I:r ~?>)h. >~ 4n.k {: r: r~ ( I •)
<br /> MEASUREMENT '\
<br />Nr~ rV.II ,VII /~' :A
<br />I •rlr .
<br />. , J U :.:~;:'::: PERMIT~:;::~:
<br />.
<br />..:
<br />..
<br />.. :~.::~CfsX i?.;ez..:
<br />: .•'~:a}!;x. zt.!k~>x~t... ~y :_'. ;;'7d:~"e:;ei"A;:~~r .~~iJ?~.r$.~!G~!#~:~s.'s: ~~`:~":;:::.;.':.:':::'.: :..:'.::
<br />1
<br />~ .::::5 ~$a~~TI`i l2;~A~~,!~
<br />
<br />,.. ,. . ,. ,. .,. , , ....
<br />...
<br />..
<br />.
<br />.
<br />:REQUIREMENT: :::.....:...
<br />:
<br />-::...::.,::~.~:~ ~:~.~.:.::
<br />~:(l;;r.;;:.. ~'::~.~ ~::.:~: ~
<br />~ . .
<br />:
<br />.,:..:,.,....:.....:...
<br />'~4+!:r:,..:, :.,_
<br />°~ .
<br />r
<br />F ;. J',, ?? .J tii'IiIT J? SAMPLE _ ~~(
<br />~
<br />I
<br />~ ( ': 'I) ... :: i- R4h'4''r: - ~ y
<br />/J.
<br />i~"(
<br />~
<br />~'
<br />'
<br />~
<br />r.,i ill i'.:h a:°4~4T DL'h', MEASUREMENT U.
<br />~!!~ J
<br />D.
<br />~ V P-
<br />;
<br />~
<br />`
<br />r "I .l -, ~: 1 J (I :: ...
<br />[!'::.:PERMID;:
<br />'.:
<br />i`
<br />:' ~;~.' c3~P~i???T
<br />':'ci: %.'ara'.L ('n-SST:. .: -.: :X' .:
<br />,v.. •.. :=t~:(~' >.'i:. >Y. :"', s~:.,:. ~:r 4. ,. .5 ,.
<br />.
<br />.. : r>
<br />.•v: ,4.y: '. F!-,-... 'd. 1.~
<br />1. i .
<br />.
<br />.
<br />REQUIREMENT.
<br />..:.... .. ..... .
<br />..~.:.1 ~ .:..:..
<br />...:3L.~lY:.A~.V.:r` ..::..::~..~.~~
<br />i~~:'h~.1EFa.1.:.:C?:. --1
<br />.~
<br />~~
<br />
<br />.
<br />
<br />:J:,' .r:
<br />r ~.V
<br />~
<br />..
<br />'~*' qa^~ ",.'1_c~
<br />: SAMPLE
<br />MEASUREMENT rr r. '.a3a
<br />O ( ,ra) ,..._.-.: .. ,r #R'''. r-~~r ., -
<br />~' ( ~ '/
<br />~~'~
<br />: III y
<br />
<br />.:I 1„,. L ~ Q .: ,.., ..
<br />,::.:.: PERMITj~: ~.:.- '~.;".xt EE.~tp ::"i
<br />~:: ~. -
<br />.. .. ..:.;.. .ii
<br />3
<br />~7.~. ~~.~
<br />T
<br />...
<br />F`
<br />_ _
<br />.. -'
<br />~: r~aac^#~~~.
<br />r$~%r.:A`iC''tC/tx~eb.:.~ .,ai s4:;t's;r.6:#'.
<br />' hi•. (: ~ar-~,v
<br />.i.a.. M.
<br />I~'.'.7 I.
<br />...cL7.: `.. ,., ~ 'RE.QUIREMENT: ..
<br />.
<br />.;::~: .
<br />.
<br />..
<br />. .~.~=.i :.,. ~.:
<br />
<br />:. .,h~, ;.
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 'nmyu er wnx ryon.. m.l rx b ee.vmem ..a .x mKhmenb.ere ~ TELEPHONE DATE
<br /> prtP•..a..a..m,al.one.e..,R ,.limm...ora.....un.,nr... a..ax..a _
<br /> m.wR ma y..xn,eE.no..e PpPrn,Lmr...e ..de.u nr lxrom.n.. -
<br />` !
<br />R1Chard .41115 tix,nru.a. seas.m>Lym.,dN.p.m.«pene,w.nam...E.x.,nr.m. > y]
<br />
<br />i
<br />l t4
<br />E
<br />h ..r~E.,,.~arKn,.~EeweN~ FxAnlwF rrm mr n..xe.c m. mrom..xe. /i
<br />ronmenta
<br />nv
<br />a
<br />ayer .,nmIrINN.IGr~rx.>,.rm,L.w.~,..na,.x.r,r.~...n,r.,l....~romxln..
<br />I
<br />~
<br />.
<br />u
<br />I ln
<br />a
<br />Nn
<br />v
<br />EIONATURE OF MIINCMAL EXECUTIVE 970 870-27 ~( ~C
<br />,
<br /> .
<br />n.
<br />.n
<br />.
<br />rn.re
<br />x
<br />cin
<br />Frnxlrla rer nnMUmx r.t: mrorm.lle.,
<br />TYPED OR PRINTED lo,mamE lnr pveenn,wn.r.nalmPno....r rw x.o.mE .le.ue~v oFflCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF Anr v1ULATIONS /Rdnnn •// •rrehmmb hn•1
<br />;1... ~ •~~,*•. Lr•l F.. ,°S~, -. .:T°LEe.F'LF, 57 L: ;:, (~~.. .,.) .... ,~;LY i" C= i-'':i, '1!-!': I`-"CIp .Y. I •
<br />.-v.li v: I'• ., i.rv•r/, 7~ f1, F'.);: 4iJ 41)F''J ')i'' ni:~!~F- rr, i ~' ..i• )IL .. ;~c4i --_I, ~' ~;1 ~'1T qL:T! T•8•I. ~.• :1.
<br />r
<br />EPA Form J320-1 ~, 3/99) Previous editions may be used. ~.: ~ 1 ~ ,i ~ U 1~~s3111 aJ4-.Q~njf~ rm. PAGE ~oF
<br />tee.:..
<br />
|