Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include <br />Faeiliq' Name/Loearinn if dilferenU <br />NAME _ ___ y_. ~ _.._i:.1 ~~ _ _.....y-_..._.~ - - <br />ADDRESS <br />--__1_i-___-----_y.~._! --- <br />FACILITY <br />- - - - - - - - <br />LOCATION <br />---- --------------- <br />r.. c , t r... . _ - . <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (D,HRI <br />(?-161 (17-I9/ <br />.~U <br />PERMIT NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO _ <br />I?I1-111 rz?-'f1 I?J-25) 126-?71 /?.C-191 !7U-JII <br />r _ ~ Form APP+oved. <br />_ - OMB No. 2040-0004 <br />_ , - -,4pproval expires 10~3~7-96 ~ _ <br />r _ - 1.4 I . ~ -~ <br />NOTE: Read instructions before completing this form. <br /> (J Card Oul}') OUANTITT OR LOADING (4 Card Onl)'J QUALITT OR CONCENTRATION <br />PARAMETER (4h_jp <br />) (j4-6/) <br />(J6-451 (4F-5J) (j4-F1) NQ <br />EX FREOUENCr <br />DF SAMPLE <br />TYPE <br />(~~-J7j ANALVSS <br /> AVERAGE MA %IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (61611 fAa~3) fnOJU1 <br /> SAMPLE <br />MEASUREMENT ~ ~ ~i•';, Y.• ~ r I /t I ~ <br />I <br />3 <br /> /• <br />l 1 <br />V• V'I-r <br />-'Lrb rl .I. V ~ PEP.MIT ... .. . .n .-~. • __ <br />. <br />, <br />- REQUIREMENT r <br />1 <br />: <br />I LI i <br />` <br />I _ <br />G . . <br />.01 :. '.) ~ ~ SAMPLE ..~ . . . 1.0 I <br />L 1 <br />/ <br />71)J~ ~,, i., MEASUREMENT /) L ^f •~ qO <br />J /j p~Q <br />t I' <br />V <br />J.IJ~~ 1 ~ ~l PERMIT 'Tc._: ~:.. .. '.si .: ': TJ ~_ ~ ' <br />~.II :JJ '] •(, , <br />• REQUIREMENT :.<..:..; s, ~ • ) ~ <br /> <br />~7 <br />.I~'• i ~ ~T ,~ .L~ <br />SAMPLE <br />MEASUREMENT <br />"J.'.:,:.. - <br />.. .... / ~n ~//~ <br />A.VIA"C/i / /n <br />O)/M!K <br />~.Q~tf,q/'C <br />t z,L q <br />I' <br />~~ <br /> G <br />O 4. <br />d <br />V JO <br />V <br />!U l` ) ~. ) PERMIT ~ .. J.':,_ ..~. = .. ). % <br />• <br /> <br />r• <br />• REQUIREMENT <br /> <br />..... <br />1 _ <br />~ <br />r _ <br /> <br />. <br />i .7.1.1 .I <br />. ~'. <br />,_ .O • '.'ll _`. V <br />_ ~ -, SAMPLE <br />MEASUREMENT - ..':'tr'v..'.~ <br />Q.7~ .1 <br />17 ~ [{ 'T <br />~ • Z(o ~ I ~~ I <br />I3 o <br />G rzl+3 <br />. <br />; <br />V 1!! <br /> <br />....'. . J .. J <br />'_ PERMIT ".' =.:'." .' Y" : {: .:: . c ... ,:i: ~ a I .I_ . <br /> <br />.. <br />- <br />~ REQUIREMENT <br />- <br />- <br />. <br />, . <br />J <br />, u.. ~. <br />... .,... r ~ r <br />L <br />.~ J •. _.. SAMPLE .e. ..:.. .. :Y: '::iY: :: <br />~ ~;".e'. `: / ~ t/ <br /> <br />MEASUREMENT I/ <br />G, ~_('3 <br />..) J ._ ') J PERMIT '..... ' .. r. ... .. i : ;:.'. .. .... .. ' <br />_ 1 P , i J~ ./ _ REQUIREMENT _ _ <br />.'l.l;'~rr .. CrJ .'J~J_°_ 1 SAMPLE <br />MEASUREMENT Ao <br />3' O'7 ~ ~~-~ •: c ::"' :t'.. Y. ;:'.-;: :v~fl:,C~: rST' <br />(J ~{7 ~ <br /> <br />1 .1 ~ _ _ .` i ... . a 6 1 / IL ~. . <br />7 U r J 1~ _ C r PERMIT ~ - r . .. .. - ~ .... <br /> REQUIREMENT <br />`~~! )_~ r'. _ .~ SAMPLE ~ ~ ~~''.:<~ , , .r~ II <br /> <br />__ <br />MEASUREMENT ~ 72{Q 2 ~~Q 3a <br />3 <br />Vr°~"rl <br />Jy JJ Jam: .J <br /> <br />I . I LJ J ._ .. .. PERMIT <br />.... ... <br />.. r <br />.. <br />.. .. ~ ~ ~ ... <br />_ REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i cERT1FV unDER RLNALTV of LAw THAr i HAVE RERSONAUV Ex AMwEO <br />' TELEPHONE D A T E <br /> ANO AM FAMILIAR WITH TL <br />E INFORMATION SUBMITTED HEREIN ANO B55E0 <br /> ON MV INQUIRY OF THOSE INOIVi0UPL5 IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATON I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE 4000RATE ANO COMPLETE I AM AWARE THpT THERE ARE <br />SIGNIFICANT PENA <br />TIES FOR S <br />BMITTING FA <br />SE I <br />FORMATION <br />N <br />G /, ~~ <br />~~•~ <br />y <br />` ~ ~7 ) <br /> <br />' N <br />. I <br />L <br />U <br />L <br />CLUDIN <br />rHE ROSSDIUTY of FwE AND IMRRISONMENT sEE le use 4 rool ANO <br />33 USC 4 x319 (ftnalli[s uW[r rh[sc slJlutts nuv inrluJC Irncs u <br />lu <br />SIGNATURE OF PRINCIPAL EXECUTIVE l ~~~, <br />~ <br />, <br /> y <br />1 <br />~ AREA <br />i TYPED OR PRINTED SIO.U(8 <br />and or mJ,irnum mrpnsonmenl o! brrurrn H monrhs <br />anJ i gars r OFFICER OR AUTHORIZED AGENT <br />CODE NUMBER YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Ke&Ten[e dll Jrta[hmenle herd <br />t' ~ ~ • ') .T] ._ • _ r•s ~~ _ .. 'J• __-% •_ lam. • • <br />_ _ / - / <br />EP Fomr0320-i IRev.'9-8B) PrevioUS etlltions may be I/SEl1. • • IREPCACES EPA FORM T-40 WMtCH MAY IJOT BE VSEDI '- ' "' - ' - - PAGE ' CF <br />_L:.~7- l.7-..:0 1 <br />