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PERMffTEE NAME/ADDRESS(Incfude Faci(iry Namr/Lacanon yDigermq Nq1 <br />NAME SzS~`j i:UAL C'7P1F"nt~Y <br />ADDRESSD R A Y' tt U [ <br />dATDzN ^ CJ NLG3a C <br />FACILITY ~CI 9~~~I . ~' <br />LOCATIONI A Y J v ti 7 C J y 1 6 3:I FROM <br />Ai:a: ',;. d3U d+?CIih7~ I;cAF.EiAL M.4Nk,_.~ <br />PARAMETER 13 Card OnB ~7 UANTITY OR~I <br />32~ <br />tAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ Form ApprOVed.s • ' ' ~ <br />DISCNAR GE MONITORING REPORT (DMR;a % I ~ J tt OMB No. 204Q-OW4 - <br />) Approval expires 05-3198 <br />IOOOG2.'.1 OOb w (5038 Nil) <br />PERMIT NUMBER DISCHARGE NUMBER F - r' 'I AL HGU'LR <br />MONITOR IOD '~ A`r'"` sc %[`.,i ld'' FLik DGhA ~~ <br />y <br />EAR MO DAY R MO D Y' <br />~ ~~ <br />r vi T. yy v v UI5C8:.k <br />~~'~ ~iJ (~( ~%+ <br /> NOTE: Read InsVUCtions before completing this form. <br />nzr7 [2s-za( (29-25) Raz» tzazs) ( 7 <br />1DING (4 Card Ony) OUANTITY~OR CONCENTRATION NO. FREOUENC SAMPLE <br /> /.98151 !4&531 !5<A1) _ EX OF TYPE <br />MINIMUM ~I-AVER-SAGE I i MAXIMUM UNITS <br />f 7) AVERAGE MAXIMUM UNIT <br />L.. ~ J ,a ~ - G 4 tt ~ l SAMPLE " "" ~'' " ' ' <br />.: r: ri I J J A E- ii K L A MEASUREMENT <br />L'.4tl3n I ) 1 P~ )I~„,.,~, <br />"FPLJ°,~T ~itO55 VALU 4lII EM~NT *~ r+ , 1~~r ~~ I='~L`d,f. <br />SAMPLE <br /> <br />SAMPLE <br />MEASUREMENT <br />iiE N°1" ".'x <br />PRINCIPAL EXECUTIVE OFFICER <br />1 5 y Mtt <br />TELEPHONE <br />POSSIBILITY OF FINE AND IMPRISONMEM. BEE 18 U.S.C. 4 1001 AND 33 U.S.C. ~ SIGNATURE OF P INCIPAL EXECUTIVE ~ r <br />4 1318. (Penem'es under these smtures may include Ones up ro 5/0,000 end w OFFICER OR UTHORIZED AGENT <br />TYPED OR PRINTED maximum lmpnsrnment c/fxrMeen6manths end5yeera.) CgpE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />~cG PAetT I. A.4 i0$ DETAILS OY~T~S? PROCEDURE. REPOkT LOWEST DI LUT10n (; EFFLUENT) a'.i [Cfi IS L6ThAL TO <br />5J+ OF TF.S[ OHGAI[ISf15 (LCSD) dK~ AS[ACH ACUTE roxICCrr TESr HEPOd': FJKA TC Una. COPI85 OR ALL <br />r Iv~ara~ ~ t 'r v ccrT s a- -- <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ PAGE OF <br />UO'JLi/JyU~1J-114J 1 <br />~YT <br />~' <br />b . <br />}I H <br />Af <br />+; <br />