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PERMITTEE NAME/ADDRESS (Include Fau)irv Name/Luronun /OBerenp <br />NAME <br />ADDRESSr7 L'.} a T^ M T w• r <br />5/.71 STAN .`!L!;'7l~nY 17 <br />°. F :' :: ° :° l'. ~. l b lr j <br />FACILITY <br />LOCATION <br />LTTYe -1_ n_ N]S M1l+:_ Cih [••.ll e;, .IE" <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR; <br />(~ 16) (I ]- 9) <br />rnn nn s.T ~.. nno <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM DO 07 ~L~rO 00 nq JC <br />(P0~211 .(22231 f2L2511~ (261]) l2B-191 (3031) <br />Form Approved. <br />OMB No. 2040-0004 <br />.. Approval expires OS-31-96 <br />°'; ;C!!';; FIT T::• SECTir;rt lE FO'.^ <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Onty) QUANTITY OR LOADING :,,, <br />~ 4.Card Onty) QUANTITY OR CONCENTRATION <br />~ NO. FREOUENC SAMPLE <br />PARAMETER (46 53) (54-61) ~ (38-45) (96-531 (5461) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UN~~% MINIMUM AVERAGE MAXIMUM UNITS <br />Isz~u91 ANALYSIS <br />(64-68) <br />(69-70 <br />'"`LILT li!T4L SAMPLE +aD{er:-~ :;~i<.;.r.r.r- s.:YtRN014d ( I'1) <br />;; g p u; y L. >. ;• MEASUREMENT <br />"I "T.7 tl l U U PERMIT LI'C to .Xr4 Or.9glp# i ri~'+ ?R it , 1~.5 TO C NCF:/ ;HAT': <br />7FLIt"~'!' GkOS~ YALG; REQUIREMENT rir'?0 _,,,~,,,`,`y`-'u= t~LlDl~#~G DAILr '!Y i9G/1. Of`CM ~ <br />:f•'7S SAMPLE :.ar.:ri ,:. tRO¢tiQr>'k ~' ft;: K:d00 ( ~,7) <br />I J T. A L r T r-,T.j ..' yt ~r v L s MEASUREMENT - <br />I1~")•rU j U U PERMIT ;cC3*rC eiri4C4#'0# qI+R~-- a~ - <br />~ RE Dfl F,? ( ~CF./ i?A.8 <br />'-FF L7F'nT Gf USS YALU' REQUIREMENT '' ` '-~'~ <br />3~DA arc <br />nA7Lr r.x ' <br />r:,/. <br />n ti R <br />F i.: L r j N : U B (I UI'i iJ P SAMPLE ( 4ri+1CtrIR Qpxll~il;t i . r.: y;:-;+r <br />i : 1~U °F' %.ThEST PLAk; MEASUREMENT <br />'~7V~U 1 U U PERMIT 9LPfJIf~` ~,;$IGPQRT 01i r"+DIEC4fl1.. -. #4'Y'1Q91~ x r:'={: !, NCE/ LyST'AP <br />EFf'LU!'iiT i.%?r_.r. YALL'f REQUIREMENT 3aDA AEG -~y~ ~S ."~(' _ <br />~~' r ~ "ririrr a SCN : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~' t~ ;,. , ~ - <br /> REOUIREMENT `~`a r4~''-.>. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - i s r3" ~ ~ <br />~ R<" -~ <br /> REQUIREMENT `~~ yy~'"- <br />- }~?~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />*,'(x <br />~`" <br />-_ 1 r <br />,; <br />.' <br /> <br />REQUIREMENT y <br />~_ '~ _ . <br />.~ , <br />- - , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n ~ ;". .. ' . <br /> REQUIREMENT <br />i f ~ ,LL <br />!+~ , U _~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED ANO ~ TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND B45ED ON MV ~ <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE TOR OBTAINING <br />~ <br />' THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ ' } <br />/( <br />~ <br />~ <br /> ACCURATE ANU COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />G THE <br />F <br />R <br />T <br />ON <br />NCLUD ~~ / <br />!/~•/ <br />~~ <br />r. , „ , Y PENALTIES FOR SUBMITTING FALSE IN <br />MA <br />I <br />. I <br />IN <br />O <br />POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 U.S.C. 4 1001 ANO 33 U.S.C. SIGNATURE OF PRINCIPAL E%ECUTIVE ~ T. I g V - ~Lr .+ % 1. I'..' ~ ~J <br />TYPED OR PRINTED maxtmum~m~sonmenr orl ~Iwae ns maonths entl5u eersnes up to 510,000 entl ar <br />P Y 1 OFFICER OR AUTHORIZED AGENT <br />/. Rte` <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) - <br />"~,.iTOi:IS.: RQ'_iIhF.71c~7'~ 5°F I.;-.1.1~~ rc;. :~. s'~'t:px"i f,r PkOCiF RfQUTAENENTS - .SF'F' :. A. 3• PG• 4. <br />.SPA Form 3320.1 (OS-95) Previous editions may not be used. (REPUICES EPA. FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />t ooo~o/aooua3- I <br />