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PERMITTEE NAME/ADDRE$$ (Include Facilin• NomdCorarion ifDi//ermQ NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM MROES)
<br />NAME T R A P P G % ~ 1. `• 1 i. •., , i '. "' . DISCHARGE MONITORING REPORT (DMR)
<br />ADDRESST i1APPt: i! !i'-_
<br />D, D, R /.~ I ~ 'PERMIT NUMBER DISCHARGE NUMBER
<br />FACILITY `' A IG C'~ d 1 h 26 MONITORING PERIOD
<br />LOCATION YEAR MO DAY YEAR MO DAY
<br />FROM O 1 O 1 O 1 TO O 1 0 3 1
<br /> QUANTITY OR LOADING QUANTITY OR C
<br />PARAMETER
<br />
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS ANaLr515
<br />t' f SAMPLE titx?7,l0 ~#d[r i:;; ~ :.`•:',`•:?;::? ( 1?) ~
<br />
<br />MEASUREMENT
<br />B /
<br />~ ~
<br />O /
<br />7
<br />~N1jlY
<br />JC~ailO 1 0 U PEPMIT ' '+0:4q ~ :
<br />I ~
<br />~x ": 't~C -t.
<br />;
<br />:
<br />
<br />1
<br />` ~
<br />. r' ' ., U c: N T 6
<br />'3J.,S VALUE R~QUIREMIEN~'
<br />
<br />~ mo.
<br />~~3 r .
<br />.~
<br />e T
<br />,
<br />,P ,r.
<br />
<br />a. ~.
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<br />~'JLIi15, T~OTaL SAMPLE ~.`
<br />¢~",. Cr,##p# $:T4#O# ~ 19) %
<br />.. 1.iP'NDED MEASUREMENT y'p ~?O . .~ j0 /u.~'//G'
<br />.tUD 1U 1 J U. ""PERMIT: n#9i?Cr.~q
<br />- RG# .i
<br />~~ .
<br />
<br />..FFLUE~T -GROSS YALU6 R.EOUIREMENT .. r
<br />#? _ ~' + _ s
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<br />~` • ~+: :_.
<br />~.?L1 US, SEfYLEANLG SAMPLE .r;:.°"-::: ^•~%~r~ ~`##~~# ( 2S)
<br /> MEASUREMENT ~O, / ~G, / Q ~~ 6~.
<br />~)77Y5 1 U 0 `„ -PJ:RMIT- - "##St 01t#•9t ;it:d6~#~#F'!>" a.?-. ~.
<br />~~-+ ~~ ~~.,~ ~+ '., u - i+t;
<br />.?r'L'JENf GROSS VAL'JF' REQUIREMENT ~ -~ ~ ~~.-A _ , w 4~ ` , j., o
<br />L~JN, TOTAL SAMPLE ;:,: :,s.F9 3'rnrs L`'k '-.:u.t:?=; :} ( ln) '~
<br />(A $ F F.) MEASUREMENT /.Of / 09 p i~V ~,~
<br />
<br />J1JUS 1 J 0
<br />.'.PERMIT -
<br />~~##p##
<br />'.i1t~1~ "''
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<br />`';clttkitgt7~C'
<br />Q~ '"-,M
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<br />cr FLUENT GROSS YALU?. R~OUIREMENT :;r.;:v +~ _ r• x
<br />1L AND. GREASc SAMPLE ,<;; ;t :+;::; ^.:; rap# Cc#C:'?~~: :.:3-~`A..',~. ( 19)
<br /> MEASUREMENT ~ /Y.y 4? N9 /Y/J
<br />J i SSl 1 0 0 ' ~`;;PJrliMli 4P'IBt¢4tYR ~ Nk ':: -
<br />um ~`i~~ * }+,
<br />tr'PLUENZ GROSS VALUc FEQUIF1fMENT ,' ~4#2 s
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<br />~; ,r' . i . •r r
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<br />F!.JN, IN CJNi)Ui i 'JR SAMPLE ( 03) 4##%'k3 >ti ,'I:#C=?=`• #al3#tlr# ~
<br />i''rtU THKA'fMENT PLAe1T MEASUREMENT D•G/Z p,vys U ~ ,N1jq..,
<br />~J u 1 0 1 U V ""+~PpAM1T > '- "~'~)a - } #`~` ` ~
<br />' " ~ C r ; ,
<br />i r' P L U E N ? G R 0:i S V A L U? RK3U1R>+MFNT. . t y' t •: C D ,,' k .• , ".;f :;
<br />" •x _, . ~. ,';. r, ~.~ # ~ i. _ s ; « i ._, ;_,
<br />'JLIUS, TOTAL SAMPLE F~aaax aaayra~ #u##:.a
<br />( IO)
<br />I SSDLYED MEASUREMENT 5-Op SOd O~ /D ~,EF~J
<br />7 U 2 y 5 1 0 U °' PERM k ss ~ ii ~
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<br />~Ff'LU°:IY GR03S 9ALUE REaFitREMENT z•.,''a ='~~ ~'#~ ~-i,- ~,.~ ~ '•"nr...~• ,
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<br />. NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER ICeniry under penalty of law that this tlocument antl all attachments were
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<br />tte SIGNATURE OF PRINCIPAL E%ECUTIVE
<br />l am aware that there ere signiacarn penalties br submining false lnbrmatlon,
<br />•~ TYPED OR PRINTED inclutlin the ossibAi otfne and im riaonment forkww+ violations. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence ell attachments here)
<br />TSS E TDTAL LRON LI;1IT5 +ILL if F. RAL9ED, AND SETTLEA3LE S:7LID5 LI~1IT APPLIED FOR C=l0IR,24HR PR°CIP EY!:VT-
<br />SF.E t3UHDEN DF PRDOF RE'~UIkEnENTS L't~DF:R I.A. 3. TDS "10NITDRING - I.i'.3. OIL ; r;F.EASE - SEE 7.N.1.(G).
<br />A orm 33 -1 ~ 99) revto s e ilions may a use ~ .-' THIS IS A 4-PART FORM PAGE OF
<br />0r1i7S/DDD717-1 i50 1 ~
<br />Form Approved.
<br />OMB No. 2040-0004
<br />tI90R
<br />(SURk Hit)
<br />F - FItiAL MCFAT
<br />POND T.D "vE'r'R GULCH ~~
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<br />ti:) DISCNAtIGF ~ 11 r'•r ~+ ~,
<br />~ Y NOTE: Read Instructions beforrfCDhSpleting this iorrt)r-
<br />ONCENTRATION NO. FREOUENC SAMPL o~; +
<br />EX OF TYPE .„
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