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PERMITTEE NAME/ADDRESS (/nclude Faciliry NamelLacarion ifDifferrnq <br />NAME CTS'%'~:~ ~."^1P'r' r(`at'7"'.aTi7`t <br />ADDRESS~f!~t;L? 1TNF' :'7'7PI°y <br />i <br />P.G. P:ilf A.4 <br />C34f ~ f l R167G <br />FACILITY <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) <br />DISCHARGE MONITORING REPORT (DMR~ <br />(2-16) 11 ]- 9) <br />^~~ t ~ nnr <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM . 1 1 TO n n 'I ~ T R <br />(2(}31) (zz-13) (24251 (zc-z~) (zaze/ (30.311 <br />Form Approved. <br />T „ ~ _ OMB No. 2040-0004 <br />Approval expires 05-31-98 <br />f~li ;.n I <br />H -.r aT.. !. T~~ %TTi Tl. ~~° C1t~. <br />.. ~. ... ...-,-,~ , : - 1 ~-~ <br />y ANOTE: Read Instructions before plating this form. <br /> (3 Care Onty) QUANTITY OR LOADING ~t (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) 5461) (3845) 4G53) (5I-Bi) EX OF TYPE <br />(32J7) AVERAGE MAXIMUM UISRS MINIMUM AVERAGE MAXIMUM UNITS <br />(e3s31 ANALYSls <br />e4-58 <br />6470 <br />JIL T"1 (< ';H^[' SAMPLE - .fix:. ( ^'l) Rr. tr'k `-~ .... <br />Y I 711 .4 L MEASUREMENT <br />1'uJhh 1 .1 'I PERMIT #* ' 9'. - `.'_1 '~' ¢#~t14#': nRte#h# YT,F/ TS[TtS <br />'~Fi': ll•1'T '~'1S<; Y1[.", REQUIREMENT j, RA }r ~~.~ <br />K <br />x~-~ " <br />'tt';;• - <br />yn <br /> SAMPLE <br /> MEASUREMENT <br /> QEQMIY; ~ ;:,~ <br /> AEQUTAEMENT ~ ,~=~.,~~ ~ ' - <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />~ ' <br /> ~tEOI <br />I <br />EM~NT ` <br /> x <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - v" .,. - t'~ - .. <br /> REQUIREMENT ,.- ~r3.~., - - ' <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT. ' ' T ' ~ `°• .Y <br />' '~ <br />' <br />~ <br />`~~ I <br />~ - <br />4e <br />-_* _~ <br /> <br />tEQUIREMENT <br />. °~ <br />1 - <br />~ <br />' <br />r <br />+ ' <br /> SAMPLE <br /> MEASUREMENT <br /> ~f~ir r <br /> REQUIREMENT `~ ~- <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> REQUIREMENT y„~ ~ -i ; <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICEfl I CERTIFY UNDEfl PENALTY OF LAW THAT I HAVE PERSONALLY EIUMINED AND <br />BASED ON MY <br />EREIN <br />A l^ /r TELEPHONE DATE <br /> AM FAMILIPA WRH THE INFORM ; <br />ND <br />ATION SUBMRTED H . <br /> <br />Mill <br />i <br />h INQUIRY OF THOSE INDNIDUAL <br />I BELIEV <br />THE INFORMATION S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E 7HE SUBMnTED INFORMATION IS TRUE, ~~ ) -yy. ~ / <br />/ <br />J <br />/ <br />J <br />/, <br />~~ ` <br />c <br />ard <br />R <br />s , <br />MPLETE <br />ACC <br />R <br />T <br />AND C I AM AWARE TRAY THERE ARE SIGNIFICAM _ <br />/L <br />C•L <br />f/ -- C r <br /> A <br />. <br />U <br />E <br />O L/ <br />G <br />/ \~ <br />// <br />, ~ ~ <br />Fnvironrnental !'anagPr <br />' PENALTIES FOR SUBMITTIN G FALSE INFORMA710N, INCLUDING THE 970- 870-2712 V b <br />, <br /> POSSIBILITY OF FINE AND IMPR ISONMENT. SEE 1B U.S C. § 1001 AND 33 U.S.L. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED §mew3'mum~~a e~e o/5eeweenem~onlW en Sl~finee upb5i0,000 eMw <br />pri reanJ pFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aelerence all attachments here) <br />.~.'`iT LEP't ,'t. `i '1 I.T'17 ! T'[e '(1TY49 Flr >I:7rP~ ~79N F't "'`T i' °V°4T-ryr• T•A. T~ D- rpr <'lr ~~"111T9CIe PMTa~~ O[r r <br />GftiiA7': G:1.1P SP"DLF' 4"PLTSIS gcJ!rToc~ T° Y*"7tLF. 541;.^•'N TS ^~SC'r,yc~, n..ro.r ^q~D[T•1r TN~+•gUCTTOVS-7.-. <br />3320-t (08.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ ^~ t y / o ~ n D <br />1 2-1'x,2 7 <br />PAGE OF <br /> <br />