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PERMITTEE NAME/ADDRESS (include Fanhrt NamrrGurarion i/Or~erenrl <br />NAME <br />ADDRESSCO:.:i e Y 0 .' I t' L <br />7/tl STATF NIG'•*RY 11 <br />FACILITY i~ F. ` ~ ^ I' <br />LOCATION <br />_.: 11164! <br />hTT~.: J. G. iIAH~ON, GFS;", .4 I. ':Fti~GE`i <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR; <br />(1 r6) (v- 9) <br />rnr-.nu r"r~ nn~ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY ; a YEAR MO DAY <br />FROM ^ 0 07 4~E TO ~~ :~ l _{ ~~ <br />(20~P11 (12-T3) (24'25 :' /26-2]1 RB-291 f30-31) <br />Form Approved. <br />r OMB No. 2040-0004 <br />'t ~?'~ Approval expires 05-31-98 <br />w r,gcylT •~qp ~-EUI TU TEYLF~" CPtF. !C <br />NOTE: Read Instructions before completing this lorm. <br /> (3 Card Only) QUANTITY OR LOADING <br />~ ((d~CaN Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER L <br />(46-53) (Sd~61J (3a-45) (46-53) (54-61) .EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNI~ MINIMUM AVERAGE MAXIMUM UNITS aNalrSls <br />6970 <br /> (ss bsl (64-6a) ) <br />IL 4.' :?t h; rC SAMPLE X::t g:x •7 r- ( ~y) fi; ,t K;$.•O {:¢;r r,Y :4b ~(r :4 y5 :}e~~. <br />~' ; -.:,) ~ I, MEASUREMENT <br />:!rlbG U h PERMIT f. .n4tl14Y$ <br />,~ ~Z <br />] <br />~`C= _ <br />QIOI <br />LI QI Ip?9te4 <br />YJc#rJdY+'r x <br />'.Y[:;r S i''K,LY ISUA} <br />}L (c, ;'T t',U53 VrL11) REQUIREMENT t;..~'P RY ":O=p ~ti.~tlFr~'"~'- ::: {:nt. <br /> SAMPLE <br /> MEASUREMENT `.jt-°' <br /> PERMIT ~ "~F~~ ~ ~: <br /> REQUIREMENT ~ ~ r" W ~r''~' <br /> ..r+...:::.y. • .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _ <br /> REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '~ <br /> REQUIREMENT ,~-~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; <br />r^ <br /> REQUIREMENT , ~ <br />„~-'r~ " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~"" x ~' - <br /> REQUIREMENT , '~s <br />'-.' <br /> y a <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~-'~ ~ ~"i "" <br /> REQUIREMENT <br />'r' ~ <br />.. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY ENAMINED AND <br />ATION SUBMITTED HEREIN <br />AND BASED ON MY TELEPHONE DATE <br /> ; <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br />C ' <br />T <br />. <br /> A <br />CURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE .+ > <br />- ~; <br />~I ,, r h, . <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U S C. § toot AND 33 U.S.C. SIGNATURE OF PRINCIPAL E%ECUTIVE -Yl.) 4f Z V - IhA'> .. ~~ ~ <br /> <br />TYPED OR PRINTED g t3t9 (PenePies under these stetules rosy mclutle Gnes up to 510.000 entl or <br />maximum imprisonment of oerwsenbmonlhs ands years.) 'OFFICER OR AUTHORIZED~AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) , <br />:'I'fLFF.FLr SOLIDS LI`.iT ~?FLIE" U7+LY IF' C='_nY?,Z4'!P P%t-CIF E:VENi I:i CL1~I""PD. TF CLAIM RPPRGV£0 Pl' w'!'^r <br />TSS t: IiiOh LIf!I?S PILL KOT NZ A??LI?^ TD R: FORT £[• Mc.~C,))pa.eEnTS ~ _~f° L•A.2, P:. S FUP BURDEN OF Fkr?('F <br />EPA ~FOrm 3320-1 ~(OB-85) Previous editions may not be usecJ ~ ~ ~ ~ ' r(REPL,CCES EPA FORM T-90 WHICH MAY NOT BE~US~D.)" ` ~ ` ~~ ` ~ ~ ` ~ `~ ` ~ ~ ~~ ~ PAGE OF <br />OOC12/000403-_ 2 <br />!c'i_..._ .. <br />