|
PERMITTEE NAME/ADDRESS (lnthde Faci/iry Name/Locarion if Di$erent)
<br />NAME ~yi: ~~ ,.+ .... ... .. .. .. ..
<br />'. - _ ~"
<br />ADDRESS`.I"', 1., 7e .~ -.+...~t.I ~ _ -u;ll-. r: ..
<br />FACILffY
<br />LOCATION
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPOESJ
<br />DISCHAa GE MONITORING REPORT (DMR~ef
<br />~,~ „ TTr,u ^nT ,
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM + " ~' TO '+'~ "~ ~ ~
<br />(20.21) l22-231 (20.25) (2621) (28-29) (3pJ1)
<br />Forth Approved.
<br />~; +,~„ OMB No. 2040-0004
<br />Approval e>rpires OS31-98
<br />(,-..v-. ~...~ ,
<br />` ~-NOTE: Read Instructions before oompletlng this form.
<br /> (3 CeN Ony) GUANTITY OR LOADING (4 Cana Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 46-53 5e-s1 38<5 46-53) 54-61 EX OF TYPE
<br />~~~ AVERAGE MAXIMUM UNfIS MINIMUM AVERAGE MAXIMUM UNRS
<br />lBas3J aNa.YSJs
<br />(64-66
<br />7
<br />69-
<br />0
<br />;:'<I'~'t~ `,?'hLll
<br />115 SAMPLE
<br />MEASUREMENT rcnrY?R 7y~~.. .: 7•L it n.....
<br />,
<br />O ~~ O. ~~ ( +.Tl l1
<br />L/ /3~ )
<br />!
<br />~-iK!
<br />
<br />O l U ~ 5 1 ^ J
<br />~
<br />A40tR 4~
<br />IRl~Or D
<br />"';'rte
<br />~~` ~
<br />
<br />~ f
<br />~'FFLUY,RT f.^'~SS +I IIL;Jr ,REOUI~EMN7 ,~ ;.. -, ^:.~~5.._A~~~
<br />," a>tirfd ,~z~ --.~ . -s~'~lY`~
<br />" !1~ ""~ 'r..!I. ; ~` '~'
<br />-
<br />..
<br />.
<br />~;
<br />F'T.OJ~ IN ': .,^.unprr ,n
<br />I %I H!: 1'ei F,A T`+°'9T I~LAr` SAMPLE
<br />MEASUREMENT
<br />OJ b~'~
<br />Ot ~~ ( (1J1 03#~+~ 1yr#>k~.+ R^..nd ri'.:
<br />O !-f
<br />3~ f
<br />~
<br />i
<br />IN71r Jl`
<br />Sp11c,U 1 " ~
<br />n0s'
<br />EdMI~~' R ~ ~ I`~lilt'. # ~. •a ~. 'srt `
<br />~i'LIfF.NT vR'155 VILpF ti .
<br />EOUIREMENT j#31~~ ~: ~(1:~~J.x l~~. ~':D _ .~~~3. ~K_'sti;Vk:~.`=- t;~ rY }7 . +~`*'.',!?
<br />GIL AKD G$P.?+3T' SAMPLE v,:-=rvRrX~ ~ n14) -.. ^+trrk;tr r:rtY~+:'.
<br />~
<br />~~
<br />!I L ~ ll,~ L MEASUREMENT ~~1~t!
<br />,,Il ):5 1 D b ~ PERMIT. ~ 7 c;-1 #4#?t O#'kCI¢~ ;,4l1V,tftltY t. 'r^ ~ R
<br />^~'i
<br />UEHT GRO55 ~~L'JF ~REQUIREMENT F,
<br />*
<br />ad ~~~~ ~~~ Nr1=0 ~~ ~ }~===~
<br />. ,
<br />«
<br />, m
<br /> SAMPLE ~~ I,11
<br /> MEASUREMENT ;~
<br /> x
<br />"
<br />~' ~i6 v
<br />x
<br /> lJ )3
<br />NT
<br />pE s. ~
<br />.r.~' ~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> --PERMIT
<br />;
<br />''~ _ - i ..L~ ,•,. ; ~ - ~ t' 1~
<br />~
<br />'
<br /> REQUIREMENT:. {
<br />j , .~_,x`i }°" a ~
<br />,
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT -
<br />~ s' .^, ~' b i •~" ~ I - ~ - ~" ~ _
<br />I ~~
<br /> REQUIREMENT - • ~ w
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT ... .. - "" - .~tl+,`
<br /> REQUIREMENT - : ~'t:",;
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />E
<br />NF
<br />RM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY EXAMINED AND
<br />AND BASED ON MV
<br />IN
<br />.~ TELEPHONE DATE
<br />
<br />
<br />Clld 1'C~ (r~{{{5
<br />'~ AM FAMILIAR WRH TH
<br />I
<br />O
<br />INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE, /
<br />/ /~/
<br />/,(„r
<br />•'~
<br />-/~
<br />I
<br />
<br />>=nvironmental 1,9ana F!f
<br />ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTIN
<br />I AM AWARE THAT THERE ARE SIGNIFICANT
<br />G FALSE INFORMATION, INCLUDING THE u
<br />~
<br />~ y
<br />/ / jjj~~nnnn+"'
<br />_
<br />
<br />)7D-S70-~7TZ
<br />
<br />T1
<br />
<br />7R
<br />
<br />S9
<br /> POSSIBILfTV OF FINE AND IMPR ISONMEM. SEE 1B U.S.C. 41001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED mexlmumPorenias under rheas smfufes may /ncWde fines up b Sfa.aoo and d
<br />pdsmmenf ol6atneen Brtforlths erMbyaers.J OFFICER OR AIfiHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY wULAI IONS (rielerence all adacnmenrs here)
<br />r'Y N F •, , ~T• _ ~•, [~ /-,e .^.r. V -+qr r Tt` • ^_rF 'lq_gr• -T
<br />=L. R T. LT T" ~, ;7' ,'a `•L ,^L~ ([.7° 1 C- e ~ ,,.~
<br />.e;iT ~i ~.D. r c T.P. ~~ ~ liie pn~, ', rip'1 F.V 7° nR.+~,c zjc-nlnl.yc.,ro~ '1Tr - -n~•~' _ _ ~'r`n'n ,. ,~T r~ T~ i~
<br />.. ^, ~ .
<br />r Y (- _
<br />EPA Form 3320.7 •(08.95) Previous editions may,not be used. ~ ~ - ~(REPLACES~EPA FORM T-4b WHICH MAY NOT BE USED.) m ^ I ; n ~ ~ c m r ,I ~_, c ~ al PAGE ~ OF
<br />
|