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PERMITTE[ NAME/ADDREB^ llnrludr NATIONAL POLLUTANT DI6CNARGE ELIMINATION 6Y6TEM 1.\'pDlJ) <br />FRr,ll1) KRmr/LarR[ion IJ digrrrnt) DISCHARGE MONITORING REPORT (DMR) <br />NwM ; II 1:'i l;, .•, 7 rlAl (~. rlb:I+Alll /z 161 I77~f91 <br />S--____--_-~-U l1___~-_--_-- <br />ADDREBB I' `I :1-1) ~'~ZD ]L__-__--___ ('l l°i ~. i •~ I <br />- - ' <br />__ '\_ ( dF7 I411I'71n 1 1 ~ ~ PERMIT NUMBER DISC NAxOE NUMB[R <br />____ ( I1 )4j 1, _l ______________ MONITORING PER100 <br />~~~.~~~~~__ _____ YEAR MO DAY YEAR MO DAY <br />--------- FROM <br />LOCATION N ; I ) I TO ) r <br />**NO DISCHARGS** <br />Form Approved <br />OMB No. 2000-0015 <br />ao~lll ru~nl u+~tq 1+l~+a u[~]a ila-)u NOTE: Reed Indruetbn6 Mloro eomplBllnq Thls loan. <br /> (J Card Only) OU ANTITY OR LOADING (~ Card Only) QUALITY OR CONCENTRATION <br />PARAMETER (~6-l3) (lldl) (JH~J) (I6-JJ) (J!~)) NO. <br />% FREOOU`NCr gAMPLE <br />TYP <br />(J1-J7) E ANAL rs15 E <br /> A VERAOE MA%IMUM UNIT6 MINIMUM AVERAGE MA%IMUM UNITS BIbJ) (6tdH) 169-70) <br /> SAMPLE <br />O_`,I'• ((FF(U(7d11 MEABVREMENT - <br />• • <br />r , , <br />• ~ x <br /> I[RYIT <br />~~ ~ ' <br />a <br />~~~ <br />~ ' • ' <br />Ir flti f~ R[OVIRd BNT !- <br />+ ,k ~* r ! k r +• ~r r ~ i. ,Y f } s /] i' T <br /> SAMPLE <br />:iI II_jI'Ii[ Tlli Ai 'i!I... MEASUREMENT a , • f • i ~, <br />(f / ( I_LIF 1'JT ) i ~ PpIMIT ":e ~' .:. ... .. ._.: r ... ~ II,G/j, p.... ~. <br />.:" <br />/. Ir I. 4r• R[OVIRlMENT :. `. .A ' .}`.. ~ •: ~. .! ~ ~~ .! ~ ~ T~• rf^ ;n <br />i /. f.'. <br /> BAM PLE <br /> MEASUREMENT <br /> ~ ~ ~ ~ - <br />. .. ~~ ~~~~ <br />rI I <br />.tlS R[OVIREMdT .p. I }"f "i. k .R J 4 1 ~x a -~ 7 1: `. . ~ ."~'/'~(}.x (. 1. <br /> SAMPLE <br />1' i' A F I F I J MEA6UREM ENT J ~ y } ~ .1 - <br /> . P[RMIT. ~ .4 <br />~ :,I1 . <br /> REOUIREM[NT F ' <br /> SAMPLE <br />1111 y I: H.I r 1.1 MEABUREM ENT <br />Y • • <br />• 1 1 ! . <br />'11'cIIC`1_ °PEIIYIT'• <br />~~ ` .. <br />~ '~ ~ <br />- 4. 711;IL „.L '~. <br /> <br />•TI I'7 RtOY1R[MLNT' •~` <br />a~~"a"`i R'' ~ <br />°r ~rs [+rY <br />~e°'k' •• ~ <br />• ~ s' <br />-It'}~~' -~ <br />~~/%_~Sf <br />~1 <br /> ewMPLE <br />i.! ` 'I?I I(; T i V I T Y ~ /I `li MEABUREM ENT ~ r } ! ~ <br /> . ~ ~ <br />.. . <br /> <br />7 it.i (1 ;^ 'REOYIRWlNY. .._.. <br />,J Y •. ,}, ° <br />}:~i.`. }, ai <br />.se~k"Z, <br />4 • k .. <br />~t,~t i~~~}° ~... <br />.~'/~'i:. <br /> BAMpL[ <br /> MEA6UREMENT <br /> <br /> <br />NAME/TITLE PRINCIPAL E%EC UTIVE OFFICER I CERTIFY UNDER PENALTY OF Lww TRAT I NAVE P[RSONALLY E1tAMIN[D <br />ANO AM FAMILIAR WITH THE INFORMATION SUBMIRED HEREIN AND BASED __ __.. ~ <br />--~ TELEPHONE D A T E <br /> 'ON MY INQUIRY OF TMO6E IHdVIDUAL6 IMMEDIATELY RESPON61BLE FOR / <br />~ /'~ ~~ <br /> <br />Dale L <br />Fenwick OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION <br />I6 TRUC ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br />%' <br />. <br />~ <br />~ <br />% <br />' - C~ <br />. <br />NIFICAHi PENALTE6 FOR SUBMITTING FALSE INFORMATION <br />INCLUdNG r <br />~ <br />> <br />_ <br />~~/ <br />/ <br />~ <br /> <br />Assisteet General ?M~nager . <br />THE PO•FIBILITV OF FINE AND IMMKONMCNT <br />SEC IB UBC 1 ICOI AND <br />303 <br />464-7951 <br />85 <br />tll ,4„ <br /> . <br />~33USC 1131 P: /hm/lw wdrr IArr muto m <br />i <br />ld <br />/ <br />I <br />110 <br />000 :eIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED nr <br />r <br />rnn up <br />P <br />. <br />PY <br />Lndror ma Jimrun rmpnronmrnl o/brtuen SmonlhJ Pnd3 ywnl OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO ~ DAY <br />,.Vnn Cn, wnY LA rLwnw,IVn Vr wnT YIVLw I,Vni Inrl[rrnar url unutnmrnV nrrrl <br />IF i fl II I.;CH~N .I n(;(IIF?kFl? IIU,!jl.,•r I IJ:, 111 Vf1:7i 1''• 1'I `'I'I'I r.( r' I 'r '. r•I:•i ',I •, <br />IIIH ('Ur+UI~TIVjTY d/11H TI!5 14`I)Tf/r it lRdjTS IlF hd)ASlil.{~}~I11. :irl "ii+I~I1 rl•i !:; '):ICI+F r`((~ITSR <br />EPA Form 3J1O.1 lO-T9) PREVIOUe EDITION TO BE U6ED <br />UNTIL SUPPLY I6 E%HA U6TED <br />BE Ufi ED., <br />iM::... J -r. <br />