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PERMITTEE NAME/ADDRESS //nclvde Fanhry NamrlGoconon ifDi$erenq <br />NAME I!ii.6fC, ISC• <br />ADDRES$,;~r.'; T'i~;'~C`Ch CI: c .."IhE`-. <br />11C! (,i;.'F}55 CF1Yi,I::JITE ICi <br />FACILITY <br />LOCATION. <br />~-.n-.'...nit CG t.c... <br />nl'?!.: J. c .'1 ..Y. •, CCnji I":\l= t11. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCIHAR GE MONITORING REPORT (DMR; 1 <br />pT- s <br />PERMIT NUMBER . DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM D 1. 4 ti 1 TO ~', . 7 J '_ <br />(N}21 (2223) (2<45) (2fi-211 (2&491 (30-31J <br />~'I~cF <br />~_.Jch .C) <br />- Eibli <br />Form Approved. - ' <br />OMB No. 2040-0004 <br />Approval expires OS-31-98 , <br />Ci`,°b <br />:E'_:I!C FCF C:7- <br />NOTE: Read Instructions beforA completing this form. <br /> (3 Certl Ony) QUANTITY OR LOADI (4 Cartl Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) (54-61J (3645) (46-53) (54-81) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM - NITS MINIMUM AVERAGE MAXIMUM UNITS <br />(fiz ~l ANALYSIS <br />(64-68) <br />69-70 <br />. t E ; C ~ .., ..... ) . r. Y SAMPLE ... :g.. , .. :: i 5 Y a A ~ e : ) <br /> <br />_ ... .: i +; 1 ~. `. r e :. ~ . ~- <br />MEASUREMENT v <br />I~.:~.!: .. i, l PERMIT [~yr;;l 0' 1 ~ <br />~ w !!'! EE- ~ EI 7 t CCFCS <br />. - ..."i'.1 b'!''; _.-;;e REQUIREMENT ~ r, ~~~> !!b y~,j r. .. -Ehi <br /> SAMPLE <br /> MEASUREMENT <br />^ <br /> PERMIT 'R u ~ <br /> REQUIREMENT ' ~' ~,, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~~ , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ "`b , '~zl-;--, <br /> REQUIREMENT r "~ti?y. ;. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~z' '" -rr~ - - <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ; ',~~;,,, <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT "Ct <br /> a;m <br />,- <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MV TELEPHONE DATE <br /> INOUIRV OF THOSE INDIVIDUAL S IMMEDIATELY RESPON ; <br />SIBLE FOR OBTAINING <br />J ~ ~ <br />~ THE INFORMATION. I BELIEV <br />CC <br />RATE AND COMP <br />ETE E THE SUBMITTED IN <br />M <br />RE T <br />T T FORMATION IS TRUE, <br />ERE <br />RE S <br />G <br />IF <br />C <br />NT <br />/ <br />s•-' <br />N/C. ti- A <br />U <br />L <br />. <br />PENA <br />TIES FOR SUBMITTIN I A <br />AWA <br />HA <br />H <br />G FALSE INFORMATIO A <br />I <br />N <br />I <br />A <br />N <br />INCLUDING THE ~ <br />- ~r <br />- ' <br /> , <br />L <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE >C .,41 / ~ 2 ~ ~ 2 <br />TYPED OR PRINTED meximum(~mpnsonmentarbeMree re6umon hs end5ye9rs )es upro 570,000 entl or OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments hare) <br />_: _. I._.~ :'L.r. ?i.5'f FtC(-[C::r.i.. :eT !cSiiLi_ lF' CEitFL::'! L'chIYhTiGh AS "°Eft'ECT", CbCY.7t G 6EFF000C'IICt <br />~:riYF'7:Gt,.: ?.5 "iCl:iC:;'t". iF? LL.,!U': _ :EtI A? titiCh _°7;:I°TICELIII _ iGhif :;IF: EE4wEEt~ 7E:7 t CCD1F~1 <br />' uc c;:u~ <br />r "z ui. nLC~i~ .~r• u.T <br />ova .•-c r--i~~ n-ca~ i~: rt aru r. <br />' <br />~ <br />! -7% <br />. <br />r.-c iut~• man [rn +n <br />y <br />EPA Form 9320-7 (OB-95) r <br />Previous eitl <br />it <br />ions may not be used. (REPLA6ES EPA FORM T-40 WHICH MAY NOT BE USED.j ' <br />_ <br />~ C ; I .,~ ~ L~ - C I I I _ 3 ~ ~ ~ PAGE , OF <br />