|
P[RMITT[[ NAM[/ADDRUB (Include NATIONAL -OLLUTANT DISCHARGE ELIMINATION •YBTEM INPDes) ~ FonnApp/DVed
<br />FRrlllly NR1nr/LOrallon 1) dlOrnBl) DISCHARGE MONITORING REPORT (DMR) ENO. ZA74OO15
<br />t{sr!IE__ sr Magg CUAI_ Cn.tNluniJSnN CR M rs-1 m-s)
<br />~DD~I~_ P~NIIx 9P.U___________-- f.l)Oq~ 9 [)n4 ~ ~ '.
<br />LARHQNf)A F, PERMITNUMB[R DIECNARG[NUMBLR *RNO DISCSARGB~+`
<br />____ Cn At623 ____~_____ MONITORING PERIOD ~ ..
<br />~~~~~~_____~~~~~y`___`~___ YEAR MO DAY YEAR MO DAY
<br />}_~CATION ____________________ FROM N/1 r)I nt TO M[7 (:') Sn
<br />aaau rtA+b uet4 ur~try ur~tq n•nl NOTE: RBBd IRBlruellonB Wbro DDmplst(ny thb form.
<br /> (J Card Only) OUA NTITY OR LOADING (1 Card Only) QUALITY OR CONCENTRATION
<br />
<br />PARAMETER
<br />(!6-!!) (llfil)
<br />()da!) (~6-J!) (Jldl)
<br />NO. rpEOU [NCY
<br />DF
<br />[AM PL!
<br />
<br /> AVERAGE MA%IMUM UNITE MINIMUM AVERAGE MAXIMUM UNITE 616!) (6168) (69-70)
<br /> BAMPL[ '
<br />Flaw (EFF'~l1ENT) MEABUREMENT y # # ~ i * ~ # # # + #
<br />
<br />~~PlRMITtx'A • ..
<br />x.s
<br />..
<br />a%
<br />i
<br />.. 0° n .. x
<br />~
<br />3~°
<br />~e`
<br />b°
<br />~. .:
<br />.~
<br />~.
<br />~
<br />T
<br />a~a
<br />.. x ~:
<br /> , x
<br />n
<br />e . n
<br />y.,
<br />~ .
<br />... y wa'.. ~. .u.
<br /> BAMPL!
<br />111)() S~DAY MEABUREMENT # # * * * a # #
<br />(EFFEUFNT) ~~~'~~irn
<br />~'~ A~::: •~,:,;:
<br />"~~ ~ n .~,,.,".". ~
<br />,.
<br />.
<br />~ li/ItA
<br />I ;;' -~,'..°'
<br />~ ~ ..":
<br />~• ~
<br />^ r:,~•~• ~.a~..-...~~_ Mf./L ;u~e.• .~.e^x.;: ,
<br />
<br />n n ~ t n .
<br />REODU[MENT ~
<br />z
<br /># , .x: * .~ , a ~
<br />* i
<br />.• . ~
<br />• £-vr.".t~" Q
<br />"`iii a
<br />°.,, -
<br />Et .%3'0°:
<br />,
<br />Y.fti
<br /> BAMPLE
<br />NU(1~ ~~1)AY MEABUREMENT • 4 4 * • • • #
<br />
<br />f INFI.)IEN1)
<br />~.PUrrr %• ".:°"
<br />,'
<br />;
<br />t"
<br />'
<br />:'~
<br />
<br />~
<br />Ii/1).t
<br />I
<br />
<br />"
<br />
<br />°
<br />
<br />a
<br />~
<br />MG%L
<br /> R[OUIR[M[NT ;
<br />;
<br />.;
<br />.
<br />..~ .m°'. ~.*~"'a'.~:i~
<br />• , ~~.."f
<br />~•*°~+.•*°.. ~: . •. .Qa-.': ~#"
<br />. ::M
<br />'
<br />f`a a*"x*: :; ,"~.,. e .~'. (: F?
<br /> BAMPLE
<br />SDLI~S. TpTA1,. 5115P MEABUREMENT + # • * • •
<br />(FFF'LUENT) ~^.'..Pinwic°:."
<br />"•
<br />,"
<br />:.,..`
<br />°
<br />
<br />" ... .. T11/DA
<br />,.. °
<br />
<br />
<br />~.
<br />:" ::
<br />
<br />
<br />
<br />
<br />•
<br />.
<br />`
<br />
<br />
<br />.. _. ,. MCI/~ :;~„~ .~',":®
<br />'°
<br />
<br />
<br />.
<br /> ~REOU)R[rENT ~ - .., .
<br />..
<br />.
<br />:.:
<br />~, ~.:$•I)' " . ~~q j: ~ , •. ~ ~° ° , .> GR
<br /> BAMPLE '
<br />SIIL 11)$I TgTA~ 91i:t 11 MEABUREM[NT • ~ a a f a'
<br />(INFIUfNT) '
<br />wna+ %~.•>'~~'.;.ae~,, :~~';g'r~.~n~
<br />P' a IN,/17A °_•~~°:°~
<br />S'S •$ '~;.,~.,.,,:•
<br />x~ ,~,'~~:r"~a>~s`
<br />a ~ MC/1. a
<br />~~; x.~ss.~g~`''
<br />
<br />3 ~~~...~..~
<br />A
<br />AUnO[I Rco
<br />sire s<a`*®'L .a.m ..*°°+T,=* •.- .="+"a*°~I~. ,•~' '. ~a*~"irt"+~.: I ~;ra r.~ i>.•. ~
<br />.x,i 'tY'/s~~:< ~
<br />.; 'GA
<br /> BAMPL!
<br />f l(LIFUNM[ FECAI, MEABUREMENT * # • a * a ! • ~.
<br /> . ~ '
<br />PV R
<br />' ~%' ,e ~
<br />
<br />.
<br />° ~ a ° x A H
<br />x .95~ e.6 ~y;c
<br />a x F
<br />~'1~
<br />' ~ ~ C°R
<br />•
<br />' yn :;br.
<br />,. r
<br />p
<br />' .d'Q, dx
<br />~ ~ ~ ~. °. n
<br />1 a/Ino ®1}~ie
<br />'
<br />'H~. ~T vY.
<br />.EY~ &'..
<br />. :b'
<br />mom:
<br />:
<br />e
<br />t IT ~+
<br />t t [M[M
<br />RW . •.N*''•*
<br />~'#'.Y ,
<br />. 4
<br />°a.,a"°*
<br />.e*~ R
<br />"*~
<br />_*.'+~•~•:
<br />r,"n:n
<br />(}.
<br />. )r?(),
<br />"
<br />on" ,p
<br />~f-*'
<br />~. y
<br />,i X3.0°;~ .r I;.
<br />a..
<br /> BAMPLE
<br />PH,FIELU MEASUREMENT • # R • • a a f • • •
<br /> ~~a;
<br />tt,' s, ga=. F't R.a ~ .:
<br />~
<br />;s
<br />-' .. ~.. :: Y' .,nb
<br />
<br />"
<br />~,~
<br />D$'. ,.A
<br />.
<br />~.
<br />s= LE"` °
<br />: :':a..
<br />
<br />° fr• $~"..
<br />
<br />., e.
<br />x. A.. .
<br />
<br />": .'
<br />;
<br />`
<br /> RWVIR[M [NT. s .~.
<br />
<br />_ a °'
<br />a ,
<br />d = " ag a .. z' 1 ye 1$~,. :
<br />..x,
<br />
<br />:
<br />t'%r ~
<br />,
<br /> .-. w
<br />NAME/TITLE PRINCI-AL EXECUTIV! OFFIC[R I CERTIFY UHDFR PENALTY OF UW THAT 1 HAVE PERSONALLY EXAMINED
<br />ANp AM FAMILIAP WITH TH[ INFORMATON SUBMITT[D HEREIN
<br />AND BASED ~~ TELEPHONE O A T E
<br /> :
<br />'ON MY INOl11RY OF THOSE IHDIVIWAL$ IMM[dATELY RESPONSIBLE FOB{ ~
<br />L~
<br />J
<br />'
<br />Re
<br />nolds OBTAINING THE INFdiMATpN. I BCLIEVE THE SUBMITTED INFORMATION
<br />. L
<br />•
<br />y IS TRUE'-ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE 51(1
<br />l NKICAM PENALTIES FOR SUBMRTMG FALSE INFORMATION
<br />INCLUdNG _ ~
<br />Genera
<br />Manager .
<br />P
<br />B
<br />l
<br />F
<br />N
<br />T _ ~
<br />
<br />]]OS
<br />CiI
<br />]19
<br />~IAnrl(r~undrr
<br />Are
<br />rrw
<br />IUM+
<br />ma
<br />EEnrlWr /ne+u
<br />oOJl9
<br />SIGN TUBE PRINCIPAL EXECUTIVE
<br />303
<br />63-3440 p
<br />84
<br />10 T
<br />1/
<br />TYPED OR PRINTED .
<br />y
<br />p
<br />and/P.na+lmum imPnralmrnl P/6rtuwen lmonrhr a,ld5 yrarr.l OFFICER R AUTHORIZED AGENT A A NUMBER EAR MO DAV
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rr)rrrnrr all P(lurhlnrnr+ here)
<br />1F NO OI SCHARGE; UCC,URRFh DURING iNIY kF. P(.1RT IN. PEHI111) I?F FORT "~:p UIS~IIAkI: I."
<br />FUR f,f.1Np11CTIVITY R/UR TI)S INDIf.ATE tINITy OF 1dEAgtIRF'MENT, SF,F A('.R!4IT F[))? kFIJI!IRFMT~MT;; ~ ,
<br />~ ~
<br />EPA Form 7920.1 (RBr, )079) UNTIL SUPPLY IS EXNA LISTED D (REPLACES EPA FOflM T-~O WNICM MAY NOT BE USED~I PAGE OF
<br />
|