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PERMITTEE NAME/ADDRESS I7«Ari f«rIlryN.w/Ixerrw dDLdirarl NAME CJ..J.. ~.. 'n :. . _. .- -~. ADDRESS ~'i ~ ~ - J FACILITY LOCATION NATIONAL POLLUTANT DISCNMOE ELIMINATON SYSTEM lNPDESI DISCHARGE MONITORING REPORT lOMRI Z-761 I7-191 ~~~'i~Ci i~l~ r.J PERMIT NUMBER DISCHARGE NUMBER MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM 'i' CI; TO )) 11 -f I nnJ/r /JJ-7?I /JLJSI /Je-J 11 /J9-J9/ 13Q.?11 Form Approved. ~~, ~ ^ I o ; C C o n ~.; -~ c c OMB No. 2040-00041 •. rl y1 ~ ; ~ 1 ~ ~ Approval expires 0531-98 . ? - F7.~il:. y 'iI1705 ` NOTE: Rsed I/utructiona before completlnp this form. PARAMETER !3 Grd Onhl QUANTITY OR LOADING I<Grd Onhl QUANTITY OR CONCENTRATION ND, FREQUENCY SAMPLE !<6531 !546!1 I3B-451 106531 15<-611 E% DF TYPE 131-371 µALYS15 AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS rsJ-s]1 !54591 159-701 :J:.JJCTIYi:`" SAMPLE :tpk;=.`•: 1:Yr~ .....-::rX:~ ,.i:rk ., 2 iJ t ~l ( 1 i) iF ~ ,, t.'~ +~'Ir ~ t: `~ MEASUREMENT :JJfI 1 I; ) PERMIT. .-~-.?3+ y w.=f4b;trf L ~:kG :°::=.5=E= :rk.. '' 'Yr REJORI' F':;'J/ ! Ti(LY ~RA;s - rLJF:4T SPJ;~ VALUE REQUIREMENT ~ ~ ~ ~ ~ :k=r.:. ~ DAILY MY Ch .~ SAMPLE #:...5 G4~3G: ;: t= #,': ( 11) MEASUREMENT . Li ~.IJ 1 7 D ~~~ PERMIT..:. sZ;F+r1 ~;V~ :~~~ :~: 'icy yR~'i:§"-~ '~ tk#; 7.e ?c :.. ~ atCitlA ITr ~ ~9.D ~ ~ ~S ~BEKItY ;ASI~I'J ,r FLUENT GRDSS VALJc: REQUIREMENT Id"r)r? ~NLbi:EMiLi1 ~ MAY lIUFI~:~ SU ,I:.,1USf :iETTLf,R.:r'~ SAMPLE ...:C: ~k'k'kG^ 'k;r:ir;,::;: ,..'r!`- , ( 75) MEASUREMENT ~y; ~G 7~/;J 1 D. -. ~f'!. ~ PERMIT CL:.G Ik~M` '~G,7'2 r+= it '+`-r:::: r-~-r ~F ~•:r ..•~'r ^Y L1.5 f N~`.'f.:/ iRA !! ..~t L'J NT 6R0lS JRLJd REQUIREMENT :~.::r4r. ;,t:k: DATLY "''% `1 i./L ^+O t.'T;i . i. :. AiD GRC'ASE SAMPLE ~$SA3r :7": -k SrC::krt~ .;: :' i;Y ( L'~) MEASUREMENT +~`_i7l j t7 7 '.PERMIT rSG :r%~ '.'?Rath:: tr .. 7::, :: ~:~ r:tGrk !r }.~ C C)kTT~u. : a!{`5 .rrLlidNT GR~',° 'l0.40Q REQUIREMENT :. . DhZLY '~% "G/L ;Y4T :.JI{r IA C.'.I~~iP DR SAMPLE ( ;1~1 :::trrr~ -.. Y :, - .-...- .. ..: I~::'ia TF°AT~: PLANP MEASUREMENT . 1LJ~: 1 ;1 PERMIT P2I~V3L ,t;;p~3f x;<:xr;k;r .v;:k r ..Y^==•a='-. ~ H:'i:S :4:~TA I . .':.:J L•::IT ..~"''~`~ YAL'J h: REQUIREMENT 30DA AY> .DR TLY y% l1GD ~ :;+4-# "J>: T;~ •~Li~i7f iJ:1.L SAMPLE -.k?tc :.? .-,`•3 k3r ,.. ., ( j'j) ;i-..~:.LV:. ~~ MEASUREMENT ~'.L37 L J J PERMIT /.~G:C-:4G .^..Y'~'L-`i+-^. `v C=sue }PTT.:)Nhi. r4YL- =` t~F.PORT ":~L}' ~A? -i'':'LL.i~.r. ,its=~- !R'.J~ REQUIREMENT ~ ~ ~RY~ nY~ DAZL1 ^!X (7~:/L :~-. R:;U ..at'a', SAMPLE CT k+k~k ( ?J) xt:t ~x:-~ a;::k ` ......:.,_.,- r-~ ;yy MEASUREMENT .'~.,0 1 .. PERMIT ^~;tj6:':--Ik :; t:?JKi Y E'_=1 atirt.~:::X;' .,,r.9~ v .fi;.;a`... ..,,; Y~r/ I53RL . LL:, .1T ...r 19~ YRL~.I `; ~ REQUIREMENT i'i5P !IAA SC=J ~~ ~ "Ow^? NAME/TRIE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY OF AM FAMILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED AND RMATION SUBMITTED HEREIN; AND BASED ON ' ~ l ~ / TELEPHONE DATE MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR I BELIEVE THE SUBMITTED INFORMATION IS OBTNNING THE INFORMATION ~ / / ~~ / ~- , I , P I WME THAT THERE AAE ~) ~ / /~' ~ r I ' TRUE, ACCUMTE AND COM LETE. I AA A IFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION WCLl101NG /,^ / /!// F // / - ~ , SIGN _ I ~ ' .~ - ' L THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. ! 1001 AND 9] SIGNATURE OF PRINCIPAL E%ECUTIVE ~ - U.S.C. E t]1a. IPUWF4a ulOw- o..aw mums rr:.Y heA.d. rxwa y ro 7!0.000 AREA TYPED OR PRINTED w«n.u/mun Mfdomwnt arMlwwrarn«rN. rWaF.val OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAy COMMENTS AND E%PLANATION OF ANV VIOLATIONS !Ra/ersnce e!l strechments hare! ~..- 1Lt:AJL-. JL:'/`• LI"C: +14iY~) h'. L;-Y.., 11--{? C'3c:'In ?YS-.: ~..IJc,-1' .^. 'I: i~'. .`' •.~ l i ~ -• i'i l i.i .' I..;. 1. Ur '' ~• ~• L".~,f 'Sd31":'. :? ^4.Y ". ... ._i: ?L.4 '~ C: L'r l~C-)J• EpA Form 3320.1 108-951 Previous editions may be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED,) ~ ` _~ ~.. / f 7 1 ~ i 1 ~- ] ?':: PAGE OF