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PERMITTEE NAME)ADDRESS (Include Fucd,h' Namr/[ncouon jDiBrrenq <br />NAME <br />(:G LS;Y^. ::.,,AL C.n,;sdY. L.~. <br />ADDRESS,_ n. L,1 ~ Y ~' ° J `7 F <br />5~7J1 ~fnT~ `ill.'.":P.Y 13 <br />FACILITY O t t '. ~~: ~ C O P i~ 4? <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDES) <br />DISCHAR GE MONITORING REPORT (OMR~91 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY.=" .YEAR MO DAY <br />FROM OD C7 03.' TO UC G5 3? <br />(202n .(22.231 (2a~25)';ayg, (26 Z)j (2829) (3P31) <br />Form Approved. <br />~T /14 OMB No. 20400004 <br />pproval expires OS-31-98 <br />"ItiI?JS FTT TO JCL. 4 A fONI <br />i;75C"S0. Yli r~ r,+~. <br />'~ NOTE: ~Reatl Instructions before c- ompleting this form. <br /> (3 Card Onry) QUANTITY OR LOADING;r (4 Card Onryl QUANTITY OR CONCENTRATION NO. FgEOUENC SAMPLE <br />PARAMETER (46.5x) (54-erl •-:. (3845) (46-531 (54-611 EX OF TYPE <br />(32-37) AVERAGE MAXIMUM ~ ~NITS~ MINIMUM AVERAGE MAXIMUM UNITS <br />(sz~631 ANALYSIS <br />(84681 <br />69-70) <br /> u. <br />~:LIGS, T.;TAL SAMPLE +~.^-ra~eLlY 't:7,::n:~r. ~ :+C¢XttaC ( 1~) <br />-; ry;; :o ;;y ~, •. ~~ MEASUREMENT <br />~~:.3U i U U <br />^ PERMIT rpl9r4rRt+4 rX+GepfiRtiT i ^.r: {t ~, ° S ~. <br />.. "jQ ( FiC`:/ •APF. <br />+ <br />'i '1?'1`;~ YnLU[ <br />~£FL'it REQUIREMENT ~,; <br />. [uy>t:t ` <br />~ <br />l1 R#d <br />1QI DAILY ': if ?'':1L DTSCi+ ; <br />. <br />. ~, <br />. - <br />r <br />Y <br />, <br />I ~.. -.+' SAMPLE `.:ry~(r1:p a4r7CPa )yt~'0.':AbO ( 7 ]) <br />m ". + r MEASUREMENT ,~~_ <br />+r't';^fl L 'I U PERMIT ~XrPNR@ ~~b~'m.. >tit+'•` ~~, .y ~~ `:" <br />~ <br />~ kP_IiQFT ( RCS/ ;;iAF <br />FFLC;'ST ~n05~ YAL'J° REQUIREMENT X: [:[••. 'y ~ j!E <br />§ <br />`C 'GAILY CA *'~/;. CISCT ; <br />J L~J., Ik CU'7 CiUIT Ufi SAMPLE ( U7) nPA+YOg C4 .-:ROr .:::+){. i., <br />li 1: ri T- E; A f C L•' X T F L P S: ; MEASUREMENT <br />7C'J5U 1 U U PERMIT REYOI?T R=POR^, ~~' n •4':~O4+ArO±b-; /Orll[rQa'A % *="" C ll.^.~/ IN:iTA`~ <br /> .=i " t~~`1=;~ <br />`YFLDE\'J ~,!'J5 VnLUf REQUIREMENT 30DA AY: DAILY NX °~"' <br />~Y° t~~i.+,{, DISCtI ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ -''~' - <br /> REQUIREMENT 'v s~4 _ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT ~. , <br />'~-` - = <br />- ~ <br />n ~;~ <br />~. <br /> REQUIREMENT ' <br />_ ,.i~r : - - <br /> , _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ '~"="~ ~` ~_- <br />i :+, - <br /> SAMPLE ~~~:'~ <br /> MEASUREMENT ~• <br /> PERMIT ~' <br />~ ' <br /> REQUIREMENT ~ <br />`' <br />~. <br /> <br />~ <br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND ~ TiELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION <br />I BEUEYE THE SUBMITTED INFORMATION IS TRUE, ' <br />~ <br />.' ~ ' <br /> <br />. <br />I AM AWARE THAT THERE ARE SIGNIFICANT <br />ACCURATE AND COMPLETE u~ <br />; •, <br />~; <br />/ ( <br />/ <br /> . <br />I <br />TT <br />E <br />F <br />AT <br />U Y <br />Y <br />t~ <br />n ~ ~„ Y PENALTIES FOR SUBMI <br />ING FALS <br />ORM <br />ION, INCL <br />D <br />NG THE <br />IN <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE t8 U.S.C § rW1 AND 33 U.S.C. <br />t51GNANRE OF PRINCIPAL EXECUTIVE <br />~ (~)J <br />a~U- IL . <br />~U <br />~ +) <br /> <br />TYPED OR PRINTED § 1319. IPenellies under these stetmes may include Gnes up ro 510,000 end or <br />maximum impdsonment of Hatween6monlhs and SYears.1 {/OFFICER OR AUTHORIZED AGENT REA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Reverence all attachments here) <br />.•:ZTr,.T>..;,r.°~ i1ZRP"IF:!T_ ;E`: I.F.I.` P~. 'T. r~CE^ny Op .,: rn r :kr.,m~ _ ,- '.F. <br />.. ,, , ~LOGP R .G n.. .,.~_ ...[ PG. 4. <br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) Doo 3 e /.UO9 f ~~ ~ . PAGE ~ OF <br />. .. : a:~ <br />