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PERMITTEE NAME/ADDRESS Qndede Fnnlm• Nnme/Lo^anen fDgerenU NATIONAL POLLUTANT DISCHARGE E <br />NAME DISCHARGE MONITORIN <br />C C,Llu Y1J Cs_1AL COY'Fr 4}'~ L,^, rz rsl <br />ADDRESS~17 L,74'YU hIti?, r•r.^nl~T~+. <br />x/11 5'fA TE: 11IGHwdY 19 PERMIT NUMBER' <br />FACILITY ~ ~• ~ r ~ 3 ~' ' E 1 E II 1 MONITORIN <br />LOCATION YEAR MO DAYS <br />FROM 0(1 O / O1''T <br />P ~i'; ';: J. .l. nF"?I'I\. C°."T"iF I. 'A?:AC~F rzo~z»,rzz z31 rza~zsl <br />1TION SYSTEM (NPDES) Form Approved <br />TORT (DMR; OMB No. 2040-0004 <br />m 9l ~ T k LJ •`~ Approval expires 05-3798 <br />RD? : f:; i)?'r '~L;) <br />DISCHARGE NUMBER ~ - I'T •. A L *,tJ F A'. <br />RIOD '.a E':r/"='~ `•F'DI TO TR Y1. C, fi f'uc..r <br />AR MO OAY <br />UC U9 'U ^ryK, ti0 Ci=ClIARGE: ~_~( ~"`~` <br />z~l rze 2sr r30-311 NOTE: Read Instructions before complellnp this form. <br /> (3 Cerd OnN/ QUANTITY OR LOADINO•~ - (4 Card OnN) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4853) (S4~b1) `7 (38-45) (4B-531 (54-61) EX OF TYPE <br />(32-371 AVERAGE MAXIMUM UN~I~TS MINIMUM AVERAGE MAXIMUM UNITS <br />raz-631 ANALYSIS <br />(s4~fia1 <br />(6&7U) <br />r' SAMPLE x:n;xryy :x o+X t,':'• kG4+::'.: ~: { :,') <br /> MEASUREEENT <br />!, ~,LVU 1 7 U <br />PERMIT P4Qt0 #Y" , <br />~ ,, '.,- #4#77tRA7 < t+l?r` _ p <br />- '. <br />. 1~t9~~f1# <br />w <br />g. (} <br />i <br />F'rY L Y <br />: N S i'I C <br />rFLU%:T Uk"SS YALUI REOUIRENIENT `y~1; " '.'- a:. ~:fi f <br />+~{(~ . <br />. <br />`:~ MAXIFl II "1 `.:U <br />=~ i.i ~''~, 'r ;, T.4L SAMPLI: ~~a9Vl4II~ ;e r: r,Tnr-:~ .. Q4LOra# ( j')~ <br />P F, F U f ri MEASUREMENT <br />I O~%S'~ 1 L' U PERMII" er4a'ke4Cc Cr w,»uryr, g rl •an ~MI~# ' <br />~ <br />" ~ <br />~~ ~ ^ <br />7~ <br />hCF/ <br />:RAS <br />E'FLUf?:T GNJS~ VALUE REQUIREMENT ~ ~~;r,v, -_,, ^ <br />, <br />^ <br />~~~~;~ „""-=~ODk" #$G VAIL4 KX `:I:/L l1C;rTN <br />':1 lPti• >:ITLeA eLt SAMPLES '`O^`'k `k `T r,. Ty ae>a lDa rats#t11#TY ( ".~) <br /> MEASUREMENT <br />',''J 74S I U ft PERMII' ti'ggRRR ~ yP#?~~; ~4Cr rr atC "~-,~~F~Q~~' O,S ! N+=°/ ;fAlS <br />rFLI!'_-LT •7 F.OF i VRLlIE REQUIREMENT # ~~3fQA ~l7iS L!IILY t(9~. :".L/' MG!'T r= <br />1.tlIN, 'fDTAL SAMPLE: .rat':-; r. '•r,.Cf+:-t:` ,... :k :*gl!r4p ( 1:/~ <br />(L S t F } MEASUREMENT <br />':1~J Ili 1 11 :1 PERMIT 4,7 tr T38s Sfk+4l /P <br />~ t,'.r':. 4##~' ~~ ;. .:, 7.I1 L RC. F./ :RA Ft <br />`FFL'1 °. 1.T .. f: ~ljj V?L1!~ REQUIREMENT T* <br />°-<,'°r'- ;e sr r•.• '. -as'. ,~' a.}~}~r' ~{F1i D~LX:Y hX "C'/I. !'!{)1~TH -- <br />:iL n~: 'I .. ~: i.ASE SAMPLE r;nre >;I [< ': -i fe:j;:.o p#bRoi# ~aIIaC. Y: of ( }~} <br /> MEASUREMENT <br />:, <br />"~ <br /> ~ <br />1'_:T `11 1 U L' PERMIT i+C4r}4Sx T; w'C4rf'Y X e:-^-.^. "YyrjTl #b4WIIII+61 ~~ C OifTIN :HAq. <br />fcFLiJ.°.'.i ~-R^.5 Y..{LUi REQUIREME?NT 'r=:::m ~ <br />~ jNS'}' iIAX ~1.~;, GF.Is'S <br />F~1'7ii, ?4 l'Oi:GUI'f :]Fi SAMPLE ( r~3) r: r: T7### :~yi:::r:.i,•~ ':'I:yr.a:a <br />T ~: d?; T r i~ a P .' e F T d L 4 !T 7 MEASUREMENT . <br />'+"vtaU 1 O U PERMIT RFFOrT RE7.OR?' =a#Y+7~F, :;~ y/1###r?QV' ~#O+P## ~. ''r't ~ F..EKLY CN4?Ab <br />:.FFLllF'.7 "FUSS VALUE REQUIREMENT 3UL'!s AYf DATL4 rX .°!~~' :, '~~' rktory': <br />- 'LIE?. T''T'AL SAMPLE [:;~,:~ : kurGdc. ( 1 i) <br />.• I S ~ rl L'~' F. G MEASUREMENT <br />!'.1 !'s ~ 1 U 0 PERMIT 79 uK:.t [c r:~~ri•.;• r .:. ,. t [.#fipOt4l. i~;: '~;`$i?ptl~X' 9f,`?Ii R'T ( T.RL'Y iRAS <br />'OFSI;r':T .:8GG5 VAL(1e REQUIREMENT r: 'k:"' :.~µ .'3QA~ xv~ nAitr !!X !•r..1L <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICEq I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITH THE INFORM <br />TIO <br />T ~ TELEPHONE DATE <br /> A <br />N SUBMIT <br />ED HEREIN; AND BASED ON MY <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />TF <br />E INRORMATIO <br />1 <br />LIE ~. <br />' <br />~ <br /> . <br />N, <br />BE <br />VE THE SUBMITTED INFORMATION IS TRUE, <br />ACCURATE AND COMPLETE <br />AM <br />WARE THA <br />THE ~~ ,{,t, <br />+ rnr/~~ <br />' <br /> . I <br />A <br />T <br />RE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDIN <br />T ( f .4 <br />/~/vl <br /> HE <br />G <br />C <br />(~r, ; .s. s P <br />551811ITY OF FINE AND IMPRISONMENT. SEE 18 U S C § 1001 AND 33 U.S.O SIGNATURE OF PRINCIPAL EXECUTIVE r <br />^ " O , ` I ,~ ~ i <br />TYPED OR PRINTED § '319. (Penalties under fnese s(elmes may mclutle lines up ro S10.W0 and or <br />mew.mum %mpnsonmen! of between 6monlhs entl5 <br />ears <br />) ~ pFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> y <br />. E <br />V V MMCN I J AN V tAYLANA 11V N V h ANY VI V LA I IUN~i (Hale/eOCe all elfaChmeO15 h8(e) - ~i <br />.r?7i.Eil:+LF. SCLIU`. LI;+IT 6~PLie.^ C,4'LY 'IF <=Tn,YF,l4!IE• i'P.ZCIP EY~X7 IJ CiAI"'0:.^-. iF CLfI" RFI'aCV'cV "Y YrC?/, <br />T:~ t. IiiOti LIaiTS itILL SOT 5F hi'F'L7°U TD E.°rCR^!!D ;"6ASitRElIEYfYS - 5FF I. R. 2, PG. 5 FGI! £URLtf.t: OF F'T7CCF <br />EPA'Foim`33261 (08-85) Previous editions may not be used. ~ ~ ~ ~ •• (REPLACES EPA FORMAT=40,;WHICM. MAY NOT BE USED:)- ~ OOOl S J DO O Y O 3 ~ 10~ 7~ J • PAGE 1 OF <br />. ,.~.i v;_., <br />