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PERMITTEE NAMF./ADDRESS (Inc/udt Fociliry NmndLocahon ijDiBe.enq <br />NAME ,.Yr •, .. •n ~~ ~. <br />ADDRESS'1I~°:i )~T~", .'i rr .'~.~ -~ .. "1f nr <br />7IU~1 I:Ac-,. ,.I ... ,.L ~~.. ~.- <br />FACILITY <br />LOCATION .l~ <br />i..r,... .;7 P,l3I:a 41. r°C1.''r - •, r. '?'IY <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPOES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMfl~ OMB No. 2040-0004 <br />-~ n n y 7 i; y n T D a T ^, r• r Approval expires OS31-9$ <br />PERMIT NUMBER DISCHARGE NUMBER c• _ r r .~ f, ~ • r T ^ <br />MONITORING PERIOD ~ ' <br />YEAR MO DAY YEAR MO DAY <br />FROM a +' ' I TO ~ ` `` ` ~ 'I' ..: q ^ (- 1 '<~. ,• <br />(zo-zl) Izz-z3)~ Izazs) lzavl [ze-zs) (3a31) NOTE: Read Instructions before completing this forth. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 46-53) 54-87 38<5) (46-53) (5481) D( OF TYPE <br />(~a>) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Tfiza+) ANALrfrs <br />(64-fiB <br />6870 <br />'+F <br />C^ <br />V'~L'A' <br />t <br />~' O <br />1 D <br />lq ( I) O ~ ~ <br />. <br />. <br />1 <br />. MEASUREMENT , ~ I I ~ <br /> PERMITI __ - ~_ i ,. .. - !~-R~+QRT s si ~ <br /> <br />-t'r'L7L: i ~It ., ;!: rlfF'1' <br />REQUIREMENT <br /> <br />~ <br />'.#0? <br />r # <br />-~'ad ~~ <br />ri <br />i' <br />'~" <br />~ M <br />-~XI Z <br />"~/L - <br />`° <br />~ <br />M , <br />'=~ <br /> <br />° t• <br />' ,. <br />~_t + <br />i , <br />. rl <br />: .,r <br />~ , _ ~, _ r t.. L [' ~ ~ <br />--> <br />'C <br />°•YY CT oL''+ <br />,':' SAMPLE <br />O <br />~ <br />S~ ~ D7I {x'T r.hM1R +~~. ~.~.ia ...t.. .:n <br />O <br />~~' <br />r) <br />_ <br />t <br />' <br />. MEASUREMENT I,~ O, <br />~U"~J ~ n <br />- <br />;PERMIT _ <br /> <br />i <br /> <br />t.; <br />'~ <br />F°LU;:\: TP•~gc 'vSf 11' "REQUIREMENT _ <br />~ODd ~° <br />~ ONfLt':-)fY s~^) ~: ~f` ~~" :4 tt' <br />' , <br />ii <br /> . ~ °° . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> u <br /> SAMPLE ~ M <br /> MEASUREMENT <br /> ,.. <br /> REOUI EMEN_T - ~ ~ w- 5,_ <br /> SAMPLE <br /> MEASUREMENT <br /> ~ }i <br />d <br />p <br />L <br />n •4 Y <br />• <br />° J <br /> <br />f~EQUI{fEMENT' !i 1- <br />> m f ~ <br />=~; T' _, •.~', 3 <br />h+ <br />i <br />i. <br />M1 <br />r ~t t ,: <br />f ?Ai . i~' .x . <br />:. <br />. <br />- <br />{ <br />~ <br />i ,}.'1- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. • ,x--,r, F. , x:-: ,. `r.-. - - -sa; <br /> REQUIREMENT - - - - ~.)4~, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - - - ';,'~"* <br />s ~,, <br /> REQUIREMENT - - ~=t~ <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERE NALLY EXMIINED AND <br />IN; AND BASED ON MV TELEPHONE DATE <br /> / <br /> <br />Qlchard 1 GlI3 INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON <br />THE INFORMATION, I BELIEVE THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, /J <br />/~~ ~ <br />//- <br />~// <br /> <br />P <br />~nvlronrna„•t~~l rt'+n:::)F <br />PENALMTIESAFOB SUBMITTING FALSE~NFORMATIO <br />NE INCLUDINGICTHE , <br />/ <br />/ <br />// ~~~~ ~" /r G((( / <br />970-87n-i~I~Z <br />~~ <br />`L 1: <br />99 <br />. <br />" POSSIBILIIV OF FlNE AND IMPRISONMENT. SEE 19 U.S.C. 41001 AND 33 U.S.C. <br />0 <br />000 <br />tl <br />f <br />3 <br />~r <br />4 SIGNATURE OF PRINCIPAL EXECUTNE <br />TYPED OR PRINTED 1 <br />, <br />en <br />d <br />r~upro <br />mev <br />imum~inprlsmmem ol6eMee BmoM/u entl5 <br />rears./ OFFICER OR AUTHORIZEDAGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (rrererence ell eMCnments Here) <br />L::.:4`1T'1: :IJ-C:, `."."i~'. _.. ,.~•:gPna^(~.~ nc.A.~ a •Inv•~nL w4Tmy,...„Tr ..-a., nT• 4fl ,f,c--rv ov;l•,T rT...~,r,-~ . <br />^~ <br />Sf1?l.£$ ('JrT.',. -`: :i... ..~T.,n., u71a~ .^.75A R"l )77~ nrt~TU^ ry.. ~r.alr~r•1,~ ncpr•,-~_T~".Z~ ^~- 1~'. <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM 7-40 WHICH MAY NOT BE USED.) ~ ~ ~ tl ^ A rt ~ ~ ,~ ~ ~ _ T ~ ~ rt PAGE 1 OF <br />