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f[RM1TT[[ NAME/ADORE!! (Include ( MIITIORwL fOILU Tw NT DIfCN wRD[ [LIY IN wTIOM IYSTLM /NPDEJI <br />Plca/ry H[RM/LDn+bn UAIJJa[nry I .DISCHARGE MONITORING REPORT /DMRI <br />3lAtl.~_~.~O~L~AL ~2~~A! ~AYE3a--~ 1~/e ~i~.rs~~ .YINO,~ <br />wonR~M3QQ~QQ~ [ALA--L_=GG-ww~''(-'^~~'-- 0 b5 pp~ (SUk1R NM) <br />_--PLAGST~P ------gL hC~`CY..~- PERMIT NUMBER 1 . RncewwR[NwP[R F _ FI:iAL <br />~~ <br />Form Approved ~q UV 2 ~An~ <br />ROmA+[~" N~ ~ 2040.0004 JJ <br />Expires 4=3091 ; <br />-------------------- MONITORING PERIOD r~nD Iv ~n,l r.u ~1'tElt} ur. :AAV r. '~6q~~GlC <br />~ACI LITy -- __----- YEAR MO DAY'- ~~ YEAR MO OAY ~~ <br />- <br />LOCATION ______ <br />PwoM. ?o ar# h0 UISCRARGE ~ <br />~ <br />r+°;~ <br />_ <br />. <br />ATTN: DEdNIS L. STEYENSON' PRESIDENT -17o.7t/ !17.13) /7 .2 ~_, l16• l !7~ I ( / NOTE: REEdinEVUCtionl before eompletinp this form. <br /> (3 Card Only) QUANTITY OR LOADING _:_ ~ (~C,rd Only) OU ALITY OR CONCENTRATION ' <br />38 <br />IJ <br />Id-03 <br />J3 <br />I <br />I <br />~' ~ <br />( <br />(~J) <br />[RFOUErvCr <br />EAMPLE <br />-ARAM[TER <br />y - <br />) <br />) (J <br />~6 <br />) <br />( <br />., _ ) ( <br />( <br />`- E% i TYP[ <br />y~ <br />(3 <br />~) ~ LVEl6 <br />wN <br />R AVERAGE . 1.1AXIM UM • <br />- ~ UNITB t -. MINIMUM AV ERAO! MA%IMUM UNITB <br />67fii) <br />(6~fi8) <br />169~7U) <br /> EAMPLE <br />ME <br />EU _ <br />- _ <br />' ~ '_ <br />~~ <br />8 <br />~D ~ Z 2) <br />//y <br />GRrtB <br /> A <br />REMiNT ~ <br />_ - I • ~ O <br />0400 1 0 0 ~• <br />~~gRM 1, ~ ~ ~~ <br />v.. ~bn <br />~ # <br />~ a <br />~ <br />' t z - ~.~ ~ <br />~ <br />' ~ <br />~~~g.y~. <br />.a` ~ ir_'14~~. u <br />~ <br />'~ ~ ~~~°~ ~~~~ <br />9; ~~~C" ~ '' <br />'~ <br />"~~~`~~ ~ <br />~ , s <br />~ , <br />~ <br /> <br />~~ <br />PPLUENT GRO55 VALUE ~~~ ~I ~ ,t$ <br />~~~~; ~ -~~ <br />~~~a~' ### a ~ „~a <br />~ ~ ~' `~ <br />OLIDS, TOTAL 'EAMPLE <br />MutUR ####0(# ##?:I#QYt <br />~] <br />- ~ `/ ~ _#>f#+b## <br />~: ,'r _" ~ .... ~ <br />~T <br />~' C <br />~ <br />~ ~~)~ <br />USPENDED CMlNT _ c. <br /> ... ~ <br />' ~~""~ P R ~~ .. <br />$ L I: ~~ ~ >~ <br />~' <br />~ ~~~ <br /> <br />FLUENT GROSS VALUE <br />~ <br />;, ~ . <br />~~ a <br />~~ ~r .e <br />S#C~ ,~ ~~~~ <br />°. ~ <br />~ <br />> ~ . <br />SL AND GREASE _ :eAMP~e ~ ####4b(? #sl##~AEi <br /> <br />- ~ n °. r 0 #~I# <br />~ <" ~ <br />° <br />~ <br />~ 7#3`i###; <br /> <br />~ 19 . <br /> <br />~ ) <br />&'l~ON EYTR-GRAY NETN MEAEUR[MENT ,_ J ? y ' <br />~ <br />a ~ c ? _ ° . <br /> ~ <br />~ ~ <br />~ " <br />~ ~ <br />PPLUENT G&OSS Y'ALUE w ,» ~- ~~ ~ <br />rmT ~x <br />~'~ <br />` ~ ~,# <br />L5 ~~~ ~ <br />"~t°` ~ . <br />g~ ~s ~~ ~- ~., ~.. ~~ s <br />LOW, N CONDUIT ORS EAMPLE <br />UR <br />T r _ nn <br />V~ .] ~C,#####~' <br />~~ <br />~ `~. ]~I####i~n• <br />_ ` `"%f #•~f Yf •if G' <br />'~; r_ <br />t <br />f) - - <br />(~ <br />"1 ~'~ <br />N~`TR/ <br />HRD TSEATN.ENT PLBNT MEAE <br />EMCN ~T/ ? . <br />y , ,. $ Y <br />~ = _. , <br />0050 - 1 ~~ 0 0 ~' ~ w~'f RI~(Ta~ I <br />~ ~ ~ .a <br />_ ~~~}@ <br />_ ~ <br />° <br />~ <br />a <br />~ ~ ~ ##z: ~ <br />' <br />~ ,~ ., . " <br />. <br />~ <br />PFLDENT GROSS `VALUE x~~ <br />s~ ~, s~ ~ ' ~ <br />~ ~ <br />~ ~ ° <br />~ -, <br />, <br />r ~~« '.~® .~~' . <br />,.## ~ ~~~. ,«,~,~ <br />OLIDS,'' TOTAL <br /> <br />_._ EAMPLe <br /> <br />MEAEUR <br />T O###C#; 9Li####~ <br /> <br />- - ~ `m '$ # <br />~= J ~ 3 ~ '~ <br />R <br />^ Ib <br />, ~' ~` ~ <br />7p Q <br />~~ I ~ <br />LL~~ / <br />~~ 19 <br />.(.- ) <br />.. _ <br />~ <br />Ip~f <br />J <br />RAT <br />~ <br />_. <br />ISS LYED - _ <br />Q [M EN - .~ ~ <br />W7 V [ <br />m L ` <br />L- I~/ / /.rG.~ Fllr <br />0295 1 . 0~. 0 ~, ~..) ~ <br />a ~~ ~~ ## ~ ~ ~' ~ ~ ~ L~~ <br />PPLUEMt GROSS VALUE N <br />~' $~ ~' Ma°A ,~ ~~:.~~~ r~i~~ ~~~ ~ 1~#~ '>. ~ ' - ~ ~ ~, ~ '~ ~ ,~... ~ ~~ '~'~ ~.».t' <br />IL AND GEEASE EAMPLE ####9~ti; .' '• _~ - <br /> <br />O (=94a~ ~ :-'.# u:_R#~' '±' I~:~?EI###: <br />~ #:~: ~:$# <br />~ <br />~ <br />~ ) ,'/~- <br />I ~ <br />SU~L <br />ISUA'L MEwEU RCM ENT = ~ _ <br />_ ~ a :r - C <br />~ _ <br />~ 0- <br />. -(/ V I <br />4066 1 0 X10 ~~ad~~ ~>~~~~~,~ <br />' ~~_~~~,~~~ _ <br />S=t ~ ~ ~~~~~ ~~# C~~~ <br />s ~,~~ #xa~ <br />" ."~ ` <br />PLUENT GRO55 VALUE - <br />~ ~ <br />~ <br />~ <br />~ ~2 ~. ~~~ v <br />Y ~ <br />0=6 ~ -{ ~ ~ <br />~ ~~ ~~' <br />~ / <br />~ ;fz:# ~ ` <br />~ . ice <br /><• <br /> r sx n~ <br />..~ c . <br />.s ~ <br />M ~ . <br />. <br />3 ~ . <br />~ , ~ <br />, <br />.. <br /> EAMPLE ~ ~.. 'J ~~ ~ = G <br />~~ _ ~- ] .-. <br /> MEAEUREM lNT ~ ~. - <br />~ 1_ = <br /> °q Y RM 4v F ~~~~+~.g ~b~ $~x '~-~R6~~( ~ ` s, ~~ ~~~ <br />• ~ .~~sg ~~~ Q. <br /> m ~ ~ ~ k» ~°a ~. 5; < o `~ a ~~ e ~ <br />~R i~K~~. ~' ~ R<~~~'0 aw 8.w"8.> <br />NAN[/TITLE PRINCIPAL E%[CUTIV! OP-ICER I CERTIFr, uNDE11 PENALTY rK .uw' THAT rNAVE PE~µLy, E%M1m[O <br />AND AY FAYILYR MTN"TYE INFORMATION SUBMITT[D <br />HEREIN <br />(AND <br />eAE[D ,f `. c <br />~ <br />- '~ TELCPNON! D A T E <br />, <br />. ; <br />: <br />~ <br />1 011 MY INQUIRY OF TNOrE IMtlV10UAL5 IMMEdAT[LY' R[S~ONSIEL[ 'FCq• <br />^yI I~2NcI OeTNNING. THE INFaRMATON 1 lELIEVE TME-.SUEYITT[D INFORYAT101{" <br />T <br />Y <br />T <br />M <br />' `1 <br />_ <br />!L ~! <br />~ <br /> <br />' <br />AM AWAR~ <br />HA <br />/ .: IS TPU[ ACCURATE AND; COMPL[TE <br />ER[ ARC <br />61 <br />~T <br />/~ <br />P[NALTIES .fOR • SUBMITTING- FALSE t1 [ORMATIQH E]INC(UIpINO <br />MIIICAHT ` - <br />V <br />. <br />-_ <br />y [~ 1r <br />5V p(VIS~ ~rl~/ A~'CUi~S THE POSB161LITr Os FINLIAND IMPRRONM[NT 5[[ IB USC 11091 AND- <br />rPrmlrN. uMrr. MrD tlR1ub. n nr/udr livl u0 m tlgnn <br />my ~ <br />3]USC f 1]1D EIGN~iURE OF PR NOIPAL EXECUTIVE <br />L, _3 boZ y~Y-szs3 ~ 07 8 <br />. <br />TYPED OR PRINTED ard..r nu~mum imOnvn~nvnn~/M1uwnAwonlA. end .S .wr..I OPFICEP OR AUTHORIZED AGENT - NUMBER YEAR MO DAY <br />~~ <br />T <br /> <br />1 <br />GOMMCNT,AND [](PLANATION OF ANY VIOLATION6 (Nr/rrmn un unucnmrnQ nrre/ <br />OIL `B~~GREASB--SEE FOOTNOTE F/, PAGE 3. QRTRL1f SAMPLING E BIEPORTING--SEE FOOTNOTE D/. <br />J% <br />Y-B8) Pnvloua Etlitlona may <br />(R[PLAC[s EPA PORN T•AO WHICH MAY NOT EE Ye[D.I OOOD4y9105u4-1426 •AQE OP <br />i <br />