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PERMfTTEE NAME/ADDRESS Qnclode F'aclliry Name/Incofion i/Dij/ermq <br />NAME ~r~' i1 -1 ~ ~ .. 1' <br />ADDRESSiII;a'~:; l~i•=? ~. ,.", ~Z"•4v Cr <br />r <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMRI <br />_ (2-16) (1l- B) <br />^707''7 1 X1'1 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ' - ~ ! TO ~~ ~' ~' ] T <br />(M31) Rz-z31 (z4P51 f26-zrl (Pa~Y9) (30.31) <br />Form Approved. <br />OMB No. 2040-0004 <br />' ~ ~ Approval expires OS31-98 <br />c _ ~~- ,17~~~ <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Cartl Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (5481) 3845 (46-53) (5461) ETC OF TYPE <br />(~~~ AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNRS aaursls <br /> (6zm) (Be-68 69-70 <br />1~1. '::~.r .~•~. SAMPLE ': >:c::c: x; 'a~?'x r<r"'` ~`~ ( ~o) m( ~/ <br />~ U~4 <br />I•~ 7 Y ". ~ k ~ - ~ ` MEASUREMENT O, ~y~ <br />r lilt .- <br />J~ <br />I CA <br />111?3 L n O PERMIT- r IP48rdr0 OcR a ?:=^• 1191?RR".><9c 1.1) T)?PtIT4~' <. !F'C@/ ' ~~'. <br />-/:'f. L' .,.. ~'~~T- Y1L11~ REOUIREFAINT <br />.. ~ ,.;;. '. -,'... L:*t~ .'~' .3(SOi; ~>/o.., b11L LT !!3- "''/T. - n~ ~~ . `#'' <br />`- L . ~ ~ .- ~ :` ! ~: 7 : " •'? 4 <br />" <br />i : <br />l <br />' <br />"' SAMPLE <br />pl °"! °I Oq 7 Q~ <br />Or 75 ~ r~ ( O 3) .... .. .. 'a # T '~ ~ #'.` ~` . ~ `` <br />,/3 UL[TD <br />. <br />. <br />.' :l . <br />; <br />\ T Y L 11 4i T MEASUREMENT 1 <br />,~OSO 1 ? J ~.~"#P~RMI7 .+~~ 1E~iL~3R~' 1-1E1~, ,, '~a '°{t~ ".• ,.;. <br />F <br />cl OL"• t' •''l55 Y.~LIIP <br />i~~0UIl7EMENT <br />~~~~ ~1K ~~ <br />0.~~~. 1': ~~ - <br />"f:9 <br />_.. <br />:,, .. - <br />.._~.-.f.. ~':~ <br />N.. <br />,-~",. <br />~ ; <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> <br />~~ .... <br />a <br /> <br />ii <br />+ C' <br />• <br /> REQ. E - ~ ~~,:. - - ~';$'i <br /> SAMPLE <br /> <br />' MEASUREMENT <br />~'~ rPERMIT _ ~~ ~~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT, ~-~;~ _ ;~ ~ } <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ - ( ~.~ r•t <br />~ ~ <br />- - .. .. <br />~ ` r <br />- <br /> REQUIREMENT ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .~ f <br /> REQUIREMENT ~ ~ _- '~m{- <br />NAME/TTfLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMfRED HERE NALLY EXAMINED AND <br />IN; AND BASED ON MV <br /> <br />~ TELEPHONE DATE <br /> <br />' Ir <br />ICf <br />'( <br />I INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON <br />E THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, / <br />/ ~ <br />~ <br />/'O <br />'. <br />:.: 1 <br />. <br />"' <br />' <br />- ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTIN I AM AWARE THAT TH <br />G FALSE INFORMATIO ERE ARE SIGNIFlCANT <br />N <br />INCLUDING THE ~~ <br />^6~ <br />(/(// <br />9~~-})~J- <br />I%~. <br />' <br />f '-.T <br />1•~I1-7r~,i 'h-1t ~ ;~ <br />' ~ <br />POSSIBILRV OF FINE AND IMPRI , <br />SONMENT <br />SEE 1B U <br />41001 AND 33 U <br />S <br />C <br />S <br />C - <br />. ` <br />- <br />~/ <br />/ <br />7 <br /> <br />Ries untla Mase s <br />§ 1316 <br />P . <br />. <br />. <br />. <br />. <br />. <br />. <br />tendaa ma <br />incNtle lu <br />b ff0 <br />000 <br />tl SIGNATURE OF PRINCIPAL E%ECUTIVE " <br />/ <br /> <br />TYPED OR PRINTED . ( <br />ans <br />y <br />res up <br />, <br />en <br />a <br />mar/mum/mpdsonmenr o/6srween6monan entl5 y9ers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all el~chments here) <br />-~1`:}IViy ~'~_~4v 1~i - .'. (i'~~'". H~Dr ^r D'1 7.T' f 'J OOV ST 1-.1 Tp rcn~n y..~Y 1F 11, T~ ~..t rsY TI!T ~ ~Tr~ro <br />"~•< <br />_.i"P La':'? .. :LLL'.'. '^ °7I~"v G::l i~ r?S4. Aqq 7T/P. 7041!1: n"1p ncnn yn.Tu~- ovn T9(`-T.?.1 ~'. 1K, <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM 1-40 WHICH MAY NOT BE USED.) ~ ~ T a ~ / n T () 4 ~ ?-? S ~ tt PAGE t OF <br />