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PERMITTEE NAME/ADDRESS llnclutle <br />Farilip~ Name/Location if dilfennN <br />NAME__ -rr-r~~f~}!~-. L~.-.. ca-:_.r~-~i--_ <br />ADDRESSTrt+r{-:~..-.f-.- <br />- -~~-r_---_ <br />FACILITY <br />LOCATION l <br />---- r• --- r----- <br />NATIONAL POLLUTANT OISCHq RGE ELIMINq TION SYSTEM (NFDES) <br />DISCHARGE MONITORING REPORT (D,NR1 <br />(?-Ib1 (I i-I91 <br />_,n. _ <br />PERMIT NUMBER D sc.An u.aeR <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM Ji, ~ ~± TO s- ~ y <br />f?0-?I/ fP~?J1 !1J-SI R6-17) (?S-'91 (10-II) <br /> <br />Fqrm Approved. <br />OMB No. 2040-0004 <br />Approval expires,t031 X94 <br />-NOTE: Read instructions before 7;ortipletin9 this form. <br /> (J Card Only' 1 QUANTITY OR LOADING (4 Card Onl) 1 QUALITY OR CONCENTRATION <br />PARAMETER <br />(J6-SJ) (!4-61J <br />(JS-451 (46-571 (54-b 11 <br />NO. <br />E% FREOUENCv <br />DF <br />SAMPLE <br />TYPE <br />(+~ 77) ANAVSIS <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS r6:-0)) IbJLFJ (69-ilJ) <br />,v-; ~ .1 _ i t.~~~. ? ... I. SAMPLE :: ::y4'p '.' ~ <br />~ ~ ..- .::.:i-iY ~ I 7 j~ \ <br /> <br />~ MEASUREMENT J /O~ , G <br />~ <br />3 <br />.. _, <br />.. <br />. )~ 1 e 7( f <br />q <br />. <br /> <br /> REQUIREMENT- __ . <br />_ n _ r <br />I }: T' <br /> <br />..... f <br />~. :Ui..L .c:i SAMPLE ..... .., .,. .... ..~~.. .:: :.. ~s. ~: l:i;_:e: i::: c 1~ <br />_ MEASUREMENT ~."T~ <br /> <br />1- 1;~ <br />., / <br />I <br />V <br />.. ~' .' PERMIT ... .. :.. .. .... .:.: .... :..: •.. - - <br />1 It li ~ REQUIREMENT ~.{ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT a <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQVIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL E%EGUTIVE OFFICER I CERTIFY UNDER PENALTY of LAw THAT I HAVE PFRSONA11v ExAMINED TELEPHONE D A T E <br /> ANO AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON MT INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORNATON I BELIEVE THE SUBMITTED INFORMFTON 6 <br /> TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE <br />F <br />F ~/ <br />~ <br />~ <br />O7 <br />r Z <br /> nLSE IN <br />SIGNIFICPNT PENALTIES FOR SUBMITTING <br />ORMATION INCLUDING <br />rHE P0951RILITY of FwE ANO IMPRISOrvmENT SEE le use S lool AND <br />5 <br />hi <br />W <br />h <br />i 'l <br />d <br />f <br />" <br />ft' SIGNATURE OF PRINCIPAL E%EGUTIVE 70 . f ~~ <br /> asa Slalu@5 may <br />1319 ( <br />na <br />n u <br />O r <br />u <br />r <br />mcs up !n <br />3 uBC <br />" <br />~ AREA <br />TYPED OR PRINTED bn.can b munlhs anJ <br />SI0009 JnJ rr ma vmum impnssnunrnl ul <br />S )'cars J OFFICER OR AUTHORIZED AGENT COD NUMBER YEAR MO DAY <br />~ <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (Nelercnce all altarhmenls ^erel <br />EPA FOtm 3320- tRev. 9'SS) PleV10115 BdIIIOrI$ rI12y YJE rl5ed. ' ' IREPLACE9 EPA'FORM T-CO WMCH MAY'NDT BE US .I ~ _ _ _ PAGE 'OF <br />.. ~ 1 - <br />