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PERMITTEE NAME/ADDRESS (Include Faci/iry NamdLOCadon i/Digerenr) <br />NAME ryN';.;e .. T'C4'"~ <br />.., ;1 IAN <br />ADDRESSgArL., yit+',_').`SPLF.i <br />P: J. n~c 5R <br />•CF.AI : CD !11525 <br />FACILITY <br />LOCATION <br />ATIti: A;::OD;°' F. VAJD11_ V.P. <br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FDfm AppfOVBd. <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-0004 <br />(z-rs) n~- c) ° r •' •1 ^ Approval expires 0531-99 <br />MIT NUMBER DISCHARGE NUMBER c _ ^ r /.' ! I •~', :` <br />MONITORING PERIOD 'I ~` ~~ ' c. ~ rl' .j T ~ rn L' T [ I. T A "'.: r rl o ; <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ TO ~,- n., ~~ ... •- .; n• ~r9bc,_~ ) ,y,_.. <br />(zazr! (zz-zsL rzs~zsl.: ~ (zG2r1 Ra-z91 l3o,Tr1 ` `NOTE: Reatl Instrucllons beto c feting this torte. <br /> (3 Card Ony) pUANTITY OR LOADING - 4Cvd Ony) QUANTITY OR CONCENTRATION ~ NO. FREOUEN SAMPLE <br />PARAMETER (46-53) (seat •' ~ (38.45) 4x53) (5x61) EX OF TYPE <br />(32-37) ~• <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />(SZdTJ ANALYSIS <br />(64-68) <br />6&70 <br />JIL A!I i) ': r~'FZ -•• SAMPLE x~xa5: ( nLL~ O~Rrhn .': ••r-`^ .-~ <br />Y T :> f! A L MEASUREMENT <br /> <br />Hu ;~iS 1 U ! PERMIT IR ,k~ " - P,S=1 . <br />~ '.-.Il04C9rd fi>Zfi##4 rt" KFF1 I59a <br />F. !' F' L it I: `: 'p G R D ; S V + L !: REQUIREMENT :~-I. <br />' ~~ ~~~'~ p. <br />~ ~ <br />„ <br />-~ 'r<y r F r -- R <br /> ~ T _ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> MIT: " ~ < `'- <br /> ~: - _ + S- s:- ~ <br /> SAMPLE <br /> MEASUREMENT <br /> -PERM ~' ~ ~~ -_ "~ i , ;mss: <br /> REQUIRE + ~,: -- .. .,> " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. :~ F•#` ~- -°''4- - <br /> REQUIREMENT ~:; <..- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - += - ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~• - <br /> REQUIREMENT ,;:"fix ~_''" "' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..;a !'r - <br />~ <br />' - <br /> REQUIREMENT ` *~:~. <br />, _~+ +, <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY E1f/JAINED AND <br />A <br />V TELEPHONE DATE <br /> <br />M AM FAMILIAR WRH THE INFORM <br />INQUIRY OF THOSE INDIVIDUAL ATION SUBMITTED HEREIN; AND B <br />SED ON M <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING /~ <br />~ .. , <br />I I Is <br />Richard THE INFORMATION <br />I BELIEV E THE SUBMITTED INFORMATION IS TRUE <br /> <br />Environmental A9anager , <br />ACCURATE AND COMPLETE. , <br />I AM AWARE THAT THERE ARE SIGNIFlCAHi <br />E <br />~ ~ ~~ ~ <br />9TO-HTO-Z`tZ <br />~/~ <br />~G <br />C <br />' ~C~ <br /> PENALTIES FOR SUBMITTIN <br />POSSIBILRY OF FINE AND IMPRI G FALSE INFORMATION, INCWDING TH <br />SONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL E%ECUTIVE µf I <br />TYPED OR PRINTED msvmum rmn sew meM of b ~theen B~moni ~ guile rtes up m Sf0,000 end or <br />pd ymrs.) OFFICER OR AIJTNORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell etlechmenls here) <br />S:;°.'L~'ANL°_ `'"TLi" LT"~7^ ~+S1dR^. F'~^ >1lY'~?0°fa P?°c-iP 'V^vT-~"' T.A.T. o•- r•r~ ~~... =+c-nr,Fw°yTc, n7; r. <br />;Pt ASE GkAa 5'A"^1,^ A`IF',1' ~I`; ar~rlLp=7 IF YT.FT9L° SV,^rN IC (;o~°~trv.T~ •~q..orv r-e.~- T~•r 7'I'~'1'9nrTiCVS-I.' .'T. <br />n.- v <br />EPA Forth 332x1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM 7.40 WHICH MAY NOT BE USED.) PAGE OF <br />