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PERMITTEE NAME/ADDRESS pnc(ude Facdtry Name/Gacanon jDifferen0 <br />NAME <br />ADORESSrHAFL'h'8 ,"IS: <br />F.C. 6C.t 1H7 <br />FACILITYCNAIG C0 8161E <br />LOCATION <br />h i'iN: 1r• GCh DC l~ kEStF'_. PNFS/G~! C,GH <br />NATgNA4 POLLUTANTDLSCHARGE ELIMINATION SYSTEM (NPDES) <br />OISCHAAGE MONITORING REPORT (OMR,~ <br />(2-161 (1]- 9) <br />~- <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM G U Q 1 TO Q <br />f20-211 (1223) (2i~25) (262]) (2629) (3031) <br />~zllc F <br />(SUBN AF) <br />F - F1AlI <br />Form Approved. <br />OMB No. 2040-0004 ~ , <br />Approval expires 0531-98 ' ~~ <br />ECEl~ <br />FUNCFF/t•]RE ~7F 7C CAF GCICE <br />4 <br />N~J 4 <br />~ ~ NOTE Res Instructions befo7e'CEmpleYng~his form. <br /> (3 Card Only) QUANTITY OR LOADING fS Cfird Ony) pUANTITY OR CONCENTRATION NO. FREOUENC SAM1P <br />PARAMETER (46-53) 54-67) (38-45) (4653) (5461) EX OF TYPE <br />('~-3i) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(6?631 ANALYSIS <br />(64-68) <br />69-70 <br />:IL AND G}iEASt SAMPLE an40II>F f 9y) #g0~0>Q CL~~>td :iACC>:6 <br />VISUAL MEASUREMENT <br />4 U t b 1 U C Ft ~ x+ 'Mf~1~Cf . ,'~'~ E c =1 ~ fllM~/lk?II,I~F r 'f?b3l+~~ t ~_ ~*~li~s4;~ic~ ~ X 1) ~`~'~; ~ <br />F F L U F. N T G ti 0 5 5 VALUE ~t3 ENt` % '.'' ~ b c D at ; , Tk ?4(4 z L~'.a ~' k . = >C p p ,-i::i <br /> SAMPLE <br /> MEASUFIEM~NT <br /> <br />r ~'> <br />.~~ <br /> <br />... - <br />~ ~:' <br />~ <br /><"ts4:4r~ <br />~ k <br />kr tJltii4 y- t <br />` <br />~ <br />3' <br />a kylff <br />r <br />~ <br />ti ., <br />. <br />r <br />k ~ <br />< <br />- _ <br /> NT : "K ~ k __ ., 4. ` . .t s.3 .. • ~a x5 .., <br />, <br />~ e ~ *I, ,, <br />,~, <br />, 1~ r> <br /> i .SAMPLE <br />MEASUREMENT '` <br />U~J <br />~ <br /> z ERMffi _ ~ : ~ r , <br />~ .i` <br /> p IgEMFNT kv'. ~ <br />C ` <br /> SAMPLE <br /> MEASUREMENT <br /> H~IQUI~~tJT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~~~~I~~~~IY` '~ <br />t. <br /> SAMPLE <br /> MEASUREMENT <br /> -k PF.R~Q -~ <br />-" <br />~ ~ .I ' <br />4~ rAt: ~ apt <br />~ <br />Y Z <br />~vv <br />'k ,•.A+ 4 p:+r1 ,a.7t ~.f~ ~ " <br /> <br /> <br />REG1f]IR~ENT <br /> <br />~ . 1 , <br />Y <br />i <br />s <br />r ~~ S'~ <br />,, v R <br />3T i5 ~'~'1 +.~ <br />,; . ~~ < - yi. - - <br /> <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> ~+a <br />~~NIIT s~ <br />4 ' '>!~~ <br />I +~~ = <br />I - '~ <br />~' <br />~ <br />a 0,=~ r 1` 'v 5 <br />z <br />M '4 't a <br /> A ~MEN€3 , a: ce ..t `~ ,fi ~ ~ , <br />:« r e £ , , .t , <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIUAp WITH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN <br />AND eASED ON MV TELEPHONE DATE <br />INOl11F1Y OF THOSE 1NDNIDUAL <br />EE I <br />MATION <br />I REDEY <br />O ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E -THE SOBMRTID~ INFO <br />ATI <br />N S-TRUE <br />. <br />TH <br />NF <br />R <br />GOIdOII Peters <br />W <br />~ <br />~ <br />A <br />C , <br />RM <br />O <br />F <br />i <br />ATIIONE <br />ICTHE <br />~ <br />70-824-4401 <br />U <br />04 <br />27 <br />. <br />PENAL <br />TIES <br />FOR <br />SURM <br />TTIN <br />POSSIBILITY OF FINE AND IMPR g <br />NCLUDING <br />G FALSE <br />N <br />M <br />ISONMEM. SEE 10 U.S.C. g 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL E7(ECUTIVE <br />4 1319. (Pnnellias under these statutes mey include fines up ro Et0,D0o and or <br />TYPED OR PRINTED ~ maximum lmpnsonmeMOl baMeen6monrhs and5years.) OFFICER OR AUTNORRED AGENT <br />A <br />NUMBER <br />YEAR <br />MO <br />qAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Ins E TOTAL IFGN L1C175 PILL EE 1,A1YPD, AIiD ~ETTLElEIE ~CLILS LIl17 AFFLIFD EC6 <-1CfcC,"e4EF FkECIF E~Eb9- <br />.,:.E BUhDPN OF FRCCF FFQUIGPIIENTS UHDEE: I.A.3. IC.' 1!CNI7CA1bG - I..E.3. CIL 6 GF.ElSE - SEE I.E.I.~C). <br />PrA orm 332 1 ) Pr v7ous'e i lori y n l LA O I A USED.) G C C 9 5/ GG C 171-1 E i 4 PAGE ` OF <br />1 <br />Y~ <br />~h~ <br />nl <br />r~.~ <br />it <br />rr <br />Ir.( <br />