|
PFRMnTEE NAMEIADDRE55 N•:wr fau~pN~/lsr.rrar l/Obr..U
<br />NAME '~;;\~~Cn G~nL 10'('3.,1
<br />ADDRESS E' • 0• N 7 k b y
<br />kAYDE:N ~.~ o1G3'1
<br />FACUm
<br />L°~T~'tHAYUIiv CG +:Jo3U
<br />ATTN. :;H*:G; flTCri r'.` .r ll~/, .. `•.z•: .-..
<br />NATIONAL POLLVTANT DISCNMOE ELMINATION 4Y4TDA /INPDESI
<br />DISCHARGE MONITORING REPORT (DAfR1
<br />CODQ(if~; . ? 011 w
<br />;..,~~PERMITNUMBER 'wxN,waENLwem
<br />tic MONITORING PERIOD
<br />YEAR MO DAYS :YEAR MO DAV
<br />FROM U l L U ~Tq U i ' 1
<br />~.
<br />SF:U. pORD DSCGH :0 GhA55Y C`r.ti.`
<br />~Of4.~pp' DISCHANiii; ~~I '""~'
<br />NOTE: ~ ilr.rd butruetlaRe br.la~ ~eompleUnp thle lam.
<br />PARAMETER QUANTITY OR LOADING ~ I. Quality Or Concentration NO. RIEOUFE"tT SAMPLE
<br /> EX ,KTNy TYPE
<br /> AVERAGE MAXIMUM UNI` MINIMUM AVERAGE MAXIMUM UNITS ,~
<br />SOLI US, 'PUPAL SAMPLE :.raaaa 49p0111a Tia4"•°i,<.r ( 19)
<br />SUSP::NpFU MEASUREMENT
<br />UUS1U 1 U U 'PERMIT .: ~:::.s:'p~e.
<br />. :' nrr'4:;;i~'::
<br />
<br />}
<br />~.. ~-..;:.
<br />,•:'+7 .a~ '.i;'. . ': aiC. /
<br />f: ;hAt)
<br />nFF'LOc.h1' GKU:iS YALU: REQUIREMENT . r.;ao{r
<br />.- 1.
<br />...
<br />1"
<br />`4:;:i 3;'A.:'`%'s <)}l.s.i i~' MG/L d". (7k'?':H
<br />~O:,I7;i, ScTTLt:dHLc; SAMPLE
<br />MEASUREMENT ...:;r~~: r,;t,yq:rt
<br />'~~ "~~~rJ;~~ ( ~~)
<br />OUS4S 1 D U : ~ PERMIT ~: "....•.::.; :, ~-. ,. ,:.1 #I,~ 'dls+k^,r:Y:k ::46Ss:i~.': ht is .1'~.•. )!iC.F_/~ 7HA3
<br />Ekk'LUk:VT Gc~` ~ YALU; .REQUIREMENT Y,ry .: 3Gva t:e:~ `:~A1::':?? :1::.'i; SL/L r,iiaT.H
<br />Ir±UN
<br />TJT.nL SAMPLE k^.rl ~'r C+VI(trDr~'flr ( 1'i)
<br />,
<br />~ A ~ F• F.) MEASUREMENT
<br />J
<br />U1J45 1 J .. ~~.
<br />PERMIT ..
<br />.. .. . .....:..
<br />, .
<br />~
<br />:..... . ' ~ ;1'/?:~s!'~r .. .:, .;,
<br />.
<br />..:~r
<br />~ : reaEl~' 3kAJ~.
<br />
<br />:: F'r'L'UETT ~w;~:;3 VALCt
<br />~REOUIREMENT
<br />.
<br />.
<br />';~::' ...: ...
<br />.~..' :~~
<br />...
<br />+~_"
<br />.
<br />~.:
<br />~
<br />:
<br />.,
<br />.1'::J'A':'.:o~.;.
<br />,
<br />,
<br />..
<br />:'s ,~r... ::`;
<br />MG/L
<br />.
<br />.
<br />tf':N~tl
<br />JIL .AYi. .,HtA~.y SAMPLE eta{:i,r:,; p,5,`:k7: ( 19)
<br /> MEASUREMENT
<br />U.15!.1 1 U J ::'...PERMIT.,. ,: -;;:::..,.,.: ...,;.._•'~::: :r::::.;::. i~`'.F'-:-:,..:. .:' ':
<br />
<br />..:.
<br />
<br />~.' :.
<br />:..,, '.
<br />..,,:.tt:
<br />!'.t'(
<br />~ ikiAti
<br />z "r FLO ct~'P r+ri055 YnLU' REQUIREMENj ..: ~ ~.. ~' .: ~ ;, .~.. ". ~ ~ .HU/L .'(:': ~: T'
<br />:;aLI~s, YOfAL SAMPLE . . ': 't 'r . . .. ( ).~)
<br />U L ~ J LV .: U MEASUREMENT .
<br />/J1'/` 1 0 G ....:PERMIT ,::..'.'='r.~.: :....:::.<. .. ~:,:: ;}i",.It'`.;:::':: "y'ia a'HREi.'
<br />:: }'FLIIc112' I:it055 YALU~ :REQUIREMENT ? .. '. .:,.,: .?c' a'E::~Y: i~ MG/L
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />
<br />~
<br />
<br />.. '
<br />. .
<br />
<br />.
<br /> ~REOUIREMENT . ~
<br />- SAMPLE
<br /> MEASUREMENT
<br /> ..'.'PERMIT ~
<br />.::.
<br />~ ~ ~ ..
<br />
<br />~
<br />
<br />~ .. ..
<br /> REQUIREMENT ~~~ ~ ~ _ ~ '
<br /> ~
<br />
<br />NAME/T77LE PRINCIPAL EXECUTNE OFFlCER r rtmq u er pen• rT a •. rn•r N N eorvmenr •nd W rrbcnmrnlr wrrt
<br />TELEPHONE
<br />DATE
<br /> Pnp•red u;Mrr m)elrenlen or dp enM«:In ttvre•n«.Iln.a~rem tlelEnad
<br /> r• •m:« rn•r qutllere penonnN pmprtl/ prbrr •M erYU•re rl:e Inrermtllon ~
<br /> nbmllrN. Bwrd nn m) Irpul7 M We romn «prnOn/.ha m•n.Ee IM rnrem, ~
<br /> oanorr prrt•:emrtcnT,an:dbl.r«pmrn.E U.l.r«m.ne:4 mrmrem,.u.n ,
<br />
<br />•ubmllrN b, brae ber el m1 LnowYep •rN Mnef. we..anrvre, •M mmp4re
<br />- / ~Z O~ 11
<br /> .
<br />I •m •.m Inrr Inert m p
<br />NOunt
<br />r
<br />N
<br />b
<br />l
<br />nM d
<br />n 610NATlIRE OF PRINgPAL EXECUTIVE
<br /> E
<br />pm
<br />n
<br />or ru
<br />m
<br />rOnE
<br />on,
<br />fom:•
<br />TYPED OR PRINTED ImualnE lnr poWenllT wnne•ne lmpAnnmenr re.l,,,o.lni.inl.un,.. OFFICER OR AUTHOpIZEU AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION yr Anr vwLAIIONS (Rra/~/Ince N/IltaMmtlnh hill
<br />!'J~ ~ tRJd LiMIT5 NILL :, r: ','AkVcL A;.9 :;i;;PL~.i'Lc =•ULJJ3 Li'!IT APPLIt6 cGtf <=lOYk,~.HH FkECIP £YENT: T3$ o
<br />I nUV LIMITS irAIVfG F~)E; >1DY'n, 14At. ?:?SCIr dY'•^' SUrJ~: ('* °G IJ SV~F OF 7LUpF J:a I.d.2. OIL E' Gk2dA5r:-:. i~: k'
<br />EPA'FOim`3320-1 (ReV~3/99) Previous'edilior['s inay be used. ~ ~ ~ G010 S/ OT ~ ~s1a44_pa~~ arm. PAGE ~ F
<br />___-_- -_ n~i ...nl..iil.ln.~:
<br />d a -WP
<br />
|