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<br />PERMriTEE NAME/ADDRESS Qwrii iwYrryNee/lermar l/DIOe.r,q <br />NAME CYi':.~_ : +: ~. { -_ _ ..- . <br />ADDRESS . .. ' .. _ . , ~ ... ~ ..' , . . ... .. <br />FAaLm <br />LOCATION <br />NATIONAL POLLUTANT DI9CNAROE ELMINATION Sf9TEM //POE$1 <br />DISCHARGE MONITORING REPORT (D R1 <br />C ~~. ~i7%1 `U (:111 .', <br />PERMIT NUMBER astNAADE NUMeu <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM L' J 1 ~: ~~: L TO J V S i <br />~a.;Js <br />:,.;UTT <br />NOTE: Rud Irlehuetlotr E~for~ compbtlnp thb form. <br />PARAMETER QUANTITY OR LOADING <br />puality or Concentration NO• mEDUENCr SAMPLE <br /> <br />E op <br />PE <br /> X AMAIYSIy TY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS <br />1 ,i SAMPLE ~. ~~#:X'k7 ;..y;t G'.cv Q##~=:::: l 1'%) <br />~ <br />;1 L :~. c:: li Y E H A d L ~, MEASUREMENT U ~ (.{ ~ p ~7 ?j ~ ~ ~ (~r1{,. <br />v ,: l.~:i 1 0 J .~:. PERMIT .. ~~- .:.riLQe^>~#~ ~. ..~:. fi rF:~Kt e}4 s .',c:1;= ~: .Lta''K'..X~;x ~t<~~. e~if~~ <br />1. ..k~~~ `y.-;.:.i:: .. <br /> <br />e ., P.'11bEE <br /> <br />~ klt6 <br /> <br />m <br />r'L.:r.,.T GHUSS V. .J: :REOUIREMEH7: t#~xu 3OUl;et'G :R.;r:~.....Y hG/L N. ;;1,FTH <br />:;. L'i ::K, PUTEN'P Ir Li 'i SAMPLE n##"'c## ###### #Y~:=### ~ ( ],9~ <br />'- ~: .; ;,V LD MEASUREMENT ~ LF]r~~ `,~ <br />~-l.J ~ ~ I~~L) ~[~ <br />,. _J:li 1 U U :.::..;PERMIT::~,;: '. ~91CIOI.#Of.'. ...: Y;:ruu+71, :, .### ~ #fix:i:xY ~~ ~~RkP!SE <br />'~":~: <br />~ ~:;R~F~.Tw~ka~~ <br />~ ~ ~ i:Ei~E/~ GRI-[y <br />...?LV!:ST li.{(D$5 .: Ii ;REQUIREMENT,: ..:.~.::'~~:~~ ~-~~ ~ .:~~. :~~. ~~~: O### . <br />: <br />]0'La A~~.b~Y'G . <br />. <br />~:'~`?$S~`:'Y :i!k, ~' MG/L ~ ~iA~C126T FH . .. . <br />r?~.H, P tlT'_..,.LY <br />~ SAMPLE c;_:~:x-::: . qtr### =s##rC# ( 19) <br />~.1~:+:LY t1i <br />~~ MEASUREMENT ~~ OQ~ ~ <br />D , CD's 1~ Z/31 ~~~ <br />~~.1J~~ 1 7 ~IQ ~~-:;.PERMIT ~ ~~ ~~~u=J'-:~~3fi:~' ::.:0:~'>~~e?.#' .' .1;:::. o'f'!,1#!A~~~I~.~,'~':. .'i.'i73 ~ Gf~a££/ Cfi~AE <br />YL:ZdT ;: dGSS YALUI REQUIREMENT F'#tc.`. 3Ga;k .AY[: ~ .:.IIT :!i;; L .S?S p'Tfi <br />?i '.AGA9h; $!'., T_ITAL SAMPLE r~:~:0#3 ##Fr:::; r. ~. ::t-#:p:~'r <br />( 1 ') <br />6/JtP, <br />It.-c:,v~H:, I.... MEASUREMENT .5~~ r7i~ Ol ~ <br />l'7 ,~~,a-a' <br />11iLJ 1 ~, U ,:!PERMIT.:. x;;m.,.~::ts- {:ivy,:;r.71' c <br />~ .>i#ri' *">rfik:= <br />.r. FIAF.`ii' <br />~ 'i.:.s'::.''::a <br />.. <br />H <br />' ~ f LUc'N ^~SJJS VALUI (REl]~REMENT ~~ :.~~ ~..: ,~ <br />~:: ~: ##W:' . <br />... . <br />34~.[r;~.. ?V~r; ~ ~.;>,:~~:.:2!;;!. <br />+A ; C:,/:, <br />e....r, II. .::iiDUIT OR SAMPLE Fro~yp <br />~ ` <br />- <br />(LOf~F~ j 03) fra#t: ;:v ###,Y~s ~;:;~s:~ f <br />I ~ <br />~ :.. THr:A ih L~4T PLI W' MEASUREMENT ('OAl <br />irrlS / <br />~ <br />Ib~bT11 n.1S , <br />([f I/~ r'~ <br />'1t ~Yl <br />'~:,: `'IU 1 U U :.:PERMIT.:~.. ~ :~. flB~.L?r'.1?~T ~ <br /> <br />: ::~. k£: 2L'.i~i.'~'. y~i~„#~'?~;: ~~~!I~#r.,..u:.::: ~ <br /> <br />:;. <br />' .. - ~t,aKL E+STA' <br />, <br /> <br />(.'dr'C GiiUSS YAL.i <br /> <br />. :REQUIREMENT: <br />.:: ,: ;.:::~ . <br />~Dwt e.~l:G :. <br />i'AT:hY• i7X <br />N.':J ... . <br /> <br />; <br />. <br />~ <br /> <br /> <br />: <br /> <br /> <br />~~ . <br />: .: '.:J uREASE SAMPLE #3#G## ( y4) ###?#4 :::,c X;yt# :c .: Rr:#;'r <br />_~ A L MEASUREMENT O 0 '~ 1 1` "•i1~4L- <br />i~.'I~.b 1 U 0 :.:.~PERMIT~.. •.-...,. ,. r,<. <br />,..,..,_' - <br />~ ..... .. ,.. <br />c5=1 ... <br />#Pk.lfi>Q#•,• <br />s>%41#4:~.: <br />rs[:.«°«a . <br />s~:':? <br />V4 ~Lt I U <br />V 5 kl <br />-: LUENT GROSS VA;.U ~REnuIREMENT. . t:>laST t9 A,1 (+U=U ua. <br /> SAMPLE <br /> MEASUREMENT <br /> ....~PERMIT'~ .~ . ~: .... <br />~ ~ ~ <br />~ ~ <br /> ~fiEQUIREMENT~ <br />~ ~ .: ~. . . <br />~ <br />NAMERITLE PRINCIPAL EXECITTIVE OFFICER 'nn,It• rr pr".,rol,. Ib,r unancumenl,ne ,u nr,rAmmunrn <br />pnp,r.a .ne.r nT mr.rn"n "r wpn.bl"n In aaord.,re .Im ..nrrn eaE,.a TELEPHONE DATE <br />Rieharei Vills le mart rbnl 9u,I1nN pen"nnM pr"pedT plbrr „M enN,le Inr Inf"rmabn <br />wbMnN. paNenm~I,quI.TNNrpen"nwpenowwbom.n.pelMCTnrm, / ~ /J / ~ A <br />N// <br />~ <br /> <br /> <br />~ i"e•~Irental Paana <br />i:r <br />- <br />or lbve pen"re elncrlT mpntlHe rer FnberlnE Nr lnf"rm,Oaa, Ibe lnf"rn,llon ~ <br />L <br />//i /~r/ s /I <br />c'0 F'?0-?7i2 <br />g <br />r, wbmluNtr, lalbebvrarmTLm.kdpe,Mbeller,rnr.uavnra.bnrnpktr. ~- ~ --- ~ <br />/ <br />~ I/ <br /> I,m,.,nu,unrn.n Ypnlnonl prn,uln mr wbnlump nM inron:utlen, 610NANRE OF TINq-AL E%ECUTIVE i •U <br />R PRWTED I,MUeInE lhr <br />"dbIIIl <br />or n,..,b ln <br />rlwnn,enr r <br />n <br />I <br />IN <br />u A A <br />TYPED O p <br />T <br />p <br />w <br />m. <br />nE . <br />, <br />na OFFICER OR AUTHORIZED AGENT <br />CODE NUMBER YEAR MO DAY <br />COMMtrvIS ArvV Cnrl.nnni wn yr nnr •w~n: was lneromce en nucnmenra nvy - <br />K_:di;NAT° LIMITS FOi; :5i r. „T'.i.LAOLr: SJLIuS (L'Ji; 'U') ;PFLY JNL- If ~= 10-Y~, <0-N;: Pri,iC7d EYE\T ;., <br />.. %.1tldG. SEE I.n.L, -~ ic, f'UR liUHL6tl OF ?n00F IiL4l'INi:"°t:'T5. ::IL r. J5F.ASE--SET FO'~TkO"t F, F/, F': ... <br />EPA Form 3J20-1 (fjev 3/99) Previous editions may be used. 0 J 016 / `This ~ a14:pa14(Onll. PAGE OF <br /> <br />