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PERMIT DRESS pnclude Fanhry Namr/lacarion fD$erent) <br />NAME 15 ey:. r:r ~.. rn:~. ,r °'.~PT`i ~: <br />ADDRESS , r.' + I '~ ~' .. ,1 ~ P I. ca <br />FACILITY <br />LOCATION <br />AT': N: P.;l OF ;r' *^4 '!,p <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM lNPDESf <br />DISCHARGE MONITORING REPORT (DMR; <br />(446) (f r- B) <br />^nD 7 1t7 nn~ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ 9 TO ° `r n T <br />!48-411 R2-431 !44451 !4&Yr) (1&4B) (3031) <br />'T : <br />1_,:110 ''•') <br />Forth Approved. <br />OMB No. 2040-0004 <br />Approval expires 05-37-98 <br />t• _ rI r pr rho T. <br />t.. .~ ~T ~r•'•r n^^ <br />~ NOTE: Read InsVUCtions befo a co I IeUng this lone. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br />PARAMETER (4653) (50.61 38-45 (48-53) 54.61 EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />leza7l ANALYSIS <br />(64-se) <br />69-70 <br />'~i.T 9e f';^4r. SAMPLE ,tr~r;:p- S::sr-:` ?•••;-n,, r •.,~ <br />f :.i S O L V ;~ ') MEASUREMENT <br />!u! +5 I .I ) PE MIT, aalx a ;yY#~: ':!-•: #R# ~ *} + ;~Hlw{!Rt D. T2?tflAL 2RCT .R~f1 <br />ll <br />t:P"L'IF:o-,i GP'1;'; Var REQUIEMENT - r'-°• iC RJR' M~l; "/r <br />, .~, _ <br />. . <br /> SAMPLE <br /> MEASUREMENT <br /> PE~~I1MIT . ~"~' <br />~ "' : ' <br /> ~AEQUI~IEM~NT - - ~ - , - - - <br /> _ <br /> SAMPLE <br /> MEASUREMENT <br /> PE4IMTI` - - _- - ..ilwi - <br /> REQUI~iEMENi ~~,'~ ~ ~~ ~ ~ ;. -^ - - , ~' - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PE MIT=- ` - ,-, - <br /> REOUIF3EMENi - ~ : ~ ;_ <br />~- <br />ri- ~ -- ~ '~" - <br /> SAMPLE <br /> MEASUREMENT <br /> - PE MIT! <br />. - - <br />- ~~a !'a- ~ <br />" I ~' <br /> AEQUI EMENT . <br />. ~ s <br />"- ~ - • <br /> . <br />.,~.. _. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT: ,~ <br />~ ~ ! <br />''~ - , <br /> REQUIREMENT ' ~' ~ ~ <br />,, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .' ,« ~' ~_:~ - ~ <br />- ~ <br />- ~ - <br />~ k-`~ <br />~ <br />- <br /> REQUIREMENT - ~ ~ „ •; - ~ j = - <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />T <br />R NALLY E%AMINED AND <br />IN <br />AND BA <br />ED <br />N MV ~! <br />~ TELEPHONE DATE <br /> <br />Richard ;Ills AM FAMILIAR WRH THE INFORMATION SUBMIT <br />ED HE <br />; <br />E <br />S <br />O <br />INDI <br />I <br />O <br />I <br />I <br />O <br />PN <br />I <br />O <br />N <br />UI /{ / <br />~ <br /> TR <br />NFORMAT <br />ION <br />B <br />EUEVE <br />THE <br />SUBMfITED <br />FO <br />RMA ON <br />IS <br />UE, <br />THE N/' <br />~ <br />~~ <br />~ <br />~ r~ <br /> <br /> <br />7 <br />Environmental 1 <br />Ona er <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />D <br />THE <br />~. <br />l,G' <br />! /Y' <br />l~.r/IL!!/Y/ <br /> <br />7D-R7O-2712 ID ~S i <br />~ <br />. <br />. PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLU <br />ING <br /> POSSIBILnV OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 0 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 5 1318. (Perellies under Vase arefules may include Bnaa up ro ff0,000 end a <br />maximum impdsOnmerad belween6mOnl/u end5ymrs.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aelerence all attachments here) <br />.. iT~LEARL." =ILT^" r.T°TT' uglYcp F74 ~ ~ :/p n r c c..r_^,c~ r ~ n^ .,c~..T apvq*c. ^TI. <br />1 4Pe 7. P F,-Tn Y ,~, ~ .V~,~~ n , <br />~i2'rAS? v: Ap '..1°I%Lk A!7AL'!;T`.' Rc?'1I°r~ :F' 7ISI?C'' ~yv:N r. '~arv•~•rc^~ ornr,v .r,wor rvr, it!°T PI/CTTnr!S-7. .° <br />Form 33261 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-90 WHICH MAY NOT BE USED.) PAGE OF <br />O x:'17 5/ 0'I n ry. ~_! 5? 7 1 <br />