Laserfiche WebLink
PERMfTTEE NAME/ADDRESS (/nclude Facdiry NmndLma(fon r/DiBerenq <br />NAME 'ys, .~.. ~~ 1 ~ .. , T.T Y -~:.. !':~' °. <br />ADDRESStIi"'i. .T„?' 1 "'1)°"~, -, w^~r,hp n~; <br />FACILITY <br />LOCATION <br />A'!".w: x;13".f- > +-Tr•v ,-~!'n~(, gTe't <br />NATIONAL POLLIrTANT DISCHARGE ELIMINATION SYSTEM MPDESJ <br />DISC(H1AR GE MONITORING REPORT (D(MR~BI <br />^`19 '1 .171 i'I n'1l i <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM I / - ~ TO '' .. 1 <br />rA11) (11-13) r10-151 (16-1]) (1519) (3031) <br />Forth Approved. -- - -- <br />^ , 1 ^ ,: OMB No. 2040-0004 <br />Approval expires OS31-9B <br />(v. to u.,~ y:.~ <br />vT•, r. 1 nr'1^. ~ m-, ["1T nvT ^7 vPr <br />~, <br />4; } <br />`A NOTE: Read Instructions before completing this form. „ <br /> (3CW On <br />y) <br />QUANTITY OR LOADING (a Caro Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER ~ <br />3 <br />(54-ST (38-45 (46-53) (5487) EX OF TYPE <br />(3Pa~) AVERAGE MAXIMUM UNITS MINIMUM AV <br />RAGE <br />E MAXIMUM UNITS re1e31 (~s4~68)S 69-70 <br />-- ~ i- .. i ' ~ SAMPLE ... - ^. 7t ~ t ^. ~_ ... - <br />y <br />L.I J ~ O ~ 5 aO ( i 1 1 /VS <br />1~ '1 ,Y I F <br />(L!~ Q <br /> MEASUREMENT 1 <br />UOfi~4 1 D -PERMIT' - rc I a .- am@r~xa#' $EgtkB! P?IQ~A~r. Lf w~: ~~/ CM RL~'~' a~~ <br /> REQUIRE NT .r t. <br />~ _ <br />~{~R7. &',A7-:: RTR R,#I. '' ` 'a. ";.: <br />.. SAMPLE '^-~i=f.^^-~ ?~R??R D T <br />T r~Y ~A. $,O~ ( 1,, ~ _1'3~ `- <br />a~g <br /> MEASUREMENT . 7 <br />0104 U U 1 U ^ -', <br />a',~PE MIT,- <br />t~ ', as R <br />= ,+~aR9P <br />~' jcF .'~'„+;.g; > '` <br />_ -` 7 "§ui'' `~ <br />~. <br />- <br />~'BRf~ <br /> <br />~ <br />. <br />'~,~ <br />'.Fr'LUEP;T ^ , <br />]"S V 7 L " _ <br />_,. <br />}~ <br />TiE(aUl EMENT ~.c <br />~` r :. •,., <br />' <br />G#: Y ~w, ~ <br />" PI` ' ;. <br />t <br />~ _ ;,~ <br />, <br />~~~` .. ~` .'. <br />ct ,.; <br />_ <br />~ , .. <br />~ lU5• J. .I. SAMPLE ~: :;. ^;tCX .-.,-. `R..~ *A~ti~a ~' n / ( 1 T, ~ N/ <br /> <br />3 J J F+ F. N U ~; J <br />MEASUREMENT <br />~i ' <br />r-~ A /n Tl <br />LUS~O o U 'r PERMIT a~aaa# ` spa !~ ` #>!l~4Rtar R$pORT - R'SM~1R+t: Q riCP1,~: t ~`" ~~ <br />~?~ COa'}'"~T5 ~+.•~.: REQUIREMENT ':>r;`~ 3bDR <br />#7': 0# <br />I <br />1.t (77t "/: ~ O97'TE I <br />" <br />~ULLUS, TU^'~I, <br />` <br />' SAMPLE ,...fir y. h~,.r ~,.. ..,y~..x:. {{ <br />)''I/ ' <br />J <br />"1~ ( 1~~ (/31 2 <br />ly~ <br />C <br />:.1 <br />. <br />" R R U ~ J MEASUREMENT 1 l <br />;iOSjU 1 U ' PERMIT 4aamaa a rx::` aaaaa+S 7; i+? 0 9C~l~ . '$#~ °~; <br />i.:'FLUENT ;Vr14 ~: v!', ,I ~• REQUIREMENT ,}+'s-`~+°s .. i!TDN "': D#CLT ~T "'':/f. Yr]4 <br />f N . <br />'!: <br />1 ~, tir,ohl.~q-1 `.~ SAMPLE 37173 `-:~ ..-.-. ~'.`-t .. ,~`-t ~'^ ~/ ( `c~T ~ / <br />r ^' <br />V <br /> <br />MEASUREMENT <br />1-~ A /A <br />A <br />1 <br />/ <br />7 D) 7 5 L D ~ PERMIT ° -a aaa a '-0L##a4i i t ~ : 3 O~IF+(k#~ `-~R ~(~ <br />'I- - Y;rtJ " - - Y) AL.`!~/ ( ~'~ '- <br />. F CO":1a :C.i +:;, REQUIREMENT N o=~ <br />.. <br />' a'T `Y , <br />-: ~I~'~'~k'~• b11~i~? ~ -- "L/L "• !709 T`!i. a ~.S^= <br />]U.... JS, ]'r^..'i 1'1'.: SAMPLE s:'.'`t:~:~^• R'X trR'JI ~ ...~r,ti .. ., <br />~ O <br />' <br />~ O <br />I ( ~~' <br />~ <br />~ ~ <br /> MEASUREMENT r / 3 ~ ((,/T <br />J U9`4 `_• 1 PERMIT as ar aaaOetR#.=; r..... aar R1R.f14?h§'-' ~~~ ~~`` ~'4 l~Cf'I, ; , <br />~'~~ <br />F°LU: m '~ ?5^, ":'."- REQUIREMENT --pr ~.t T011# ~f$ Q#ILl' 11x "" /1. ORwR , <br />q~ <br />71!. ,.4'1;43" SAMPLE <br /> <br />E ...Cx.': .'k t~.t ~.....~... ..._. <br />~/A <br />(~ n) <br />~ <br />f~1//~ <br />~~~ <br /> MEASUR <br />MENT 1 <br />"!+,sh t c ~) <br />- <br />PERMIT aaaaas aaaasa a r-..: #~axa4a aaa'n#a <br /> <br />~ <br />-C <br />1@2~'-9 <br />,~[~~'~-'~ <br />'S:':.U!'9T C~^nc~ ~ '. 'I = REQUIREMENT - ~ 3~7T r ~ _ ' <br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM UW TMAi I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN; AND BASED ON MY _ TELEPHONE DATE <br /> <br />':IC ITI r[ .i°!E INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATON, (-BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />/ <br />/~ <br /> <br />" <br />t <br />- <br />' ACCURATE AND COMPLE-rE. <br />R <br />BMITTIN 1 AM AWAr1E THAT THERE AAE SIGNIFICANT <br />INCLUDI <br />G <br />E INFORMATION <br />THE ~ <br />~f!// <br />970-87n-'1772 <br />L1~ ~!~1 'C~ 1 <br />1111/Ir <br />•.`r"i <br />C i PENALTIES FO <br />SU <br />FI <br />E AND IMPR FALS <br />, <br />NG <br />7001 AND <br />ISO <br />T <br />EE <br />S <br />C C7'~ / ' <br /> N <br />POSSIBILffY OF <br />N <br />' . S <br />18 U. <br />. <br />. § <br />NMEN <br />33 U.S.C. <br />H <br />70 <br />0 SIGNATURE OF PRINCIPAL EXECUTIVE " <br /> <br />TYPED OR PRINTED es antler <br />nse sreMes mey include <br />rlas up m 5 <br />, <br />4 1318. IPene10 <br />00 end a <br />medmum lmpnswmem of oeMeen6mmrb end3yeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reverence 811 etracnmenfs Here) <br />i,:"4NT1'i Lint": vnn ^.i T~'7S iP*PL'11L° ?1 q .^• 4nn • ~r ~- •r`_>r ) v^ r.nr ^. <br />:S.' [' ED. 5 h' T _., F' t ., 0R !147. .' 1 017. FF''?RT +~ ,. 'TTG '11°e~a_;^^ c'T-1rgr1..-, i. • n. <br />EpA Form 33261 (O$-95) Previous editions may not be used. ^ ! ^(REPLACES EPA FORM T-00 WHICH MAY NO7 BE USED.) R ~ 1 < < / ,1 n n q 1 ~_ t 5 ~ 1j PAGE 1 OF <br />