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PERMITTEE NAME/ADDRESS (Include Facilirv,Vame~Lncatian i/Digerenq <br />NAME ~.~:. ..t C, I6C'. <br />ADDRESS ;, ), ~~ ;; T :! C :. F _` C b C I . L ~~ ;' 1 ~ " :, <br />c F6'• C7t:F6:, :~ :F:L:, ..G. is 1~:: <br />c;.aal; .;~hcTl~b C~ -;'" <br />FACILITY ' ` " ~ ' <br />LOCATION. , ~ ~ . <br />~h:I:::.f,~,:1! ~., t..~ <br />nlltl. J. L ~Yi ~, Ci,_...i~•+ t <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHAR GE MONITORING REPORT (DMR; <br />(1 ]- 9) <br />GC~`_95 0] x <br />PERMIT NUMBER ~ ~iscHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM L' c 6 0 •J 1 ptq t, I, ~ t ~ ~ <br />(20-211 f22 231 124 9v ~ f26-Z71 fzB-29) (30.31) <br />Form Approved. <br />OMB No. 2040-0004 <br />" I I' ~ `•' Approval expires OS-31-95 <br />(_Ucc bCj <br />r - tIFFI tTi;S\ <br />,. ,:i.~?LC .!:: :EETihC FCF IIIF <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (q. Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-6 t) <br />(38~45J (48-53) (54-61) <br />EX <br />OF <br />TYPE <br />(32-37) <br />AVERAGE <br />MAXIMUM <br />UNITS ~ <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />rBZ 63I ANALYSIS <br />(s4-s8) <br />59-70) <br />'r F. l: ':?nTii r. li,6i <br />SAMPLE DOaria7 - <br />~ ~ ~ <br />`+'~ :; '' ~ <br />`• ; -) <br />1 < _ <br />~ <br /> <br />.. i '' c !' F' F. L r :. <br />MEASUREMENT <br />~~VU GJ <br />~ / <br />v <br />_ <br />::1 ~. .. ., C i PERMIT t~=:z~;: ,,r ' ,,aq oaoo 'i +:L~i aa5tas r <br />..: r. CL, ,F; r•1G FFiC, REQUIREMENT v"y :. >Gs; c CA YAiCE "+-,•. ~' Eb7 1-1@It <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ ~~ "' <br /> REQUIREMENT ~ <br />" ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ -u.°i - <br /> REQUIREMENT 'd `5•~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - i' :'-': - :.. ~ -`" ~ ,' 4:' ` :. - <br /> REQUIREMENT .,r '~ xi <br />I <br />' <br /> p <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ds <br />~~ - <br /> REOUIREMENT `'~ ~s'~ <br /> I'. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ -` <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF L <br />AM FAMILIAR WITH THE INFORM AW THAT 1 HAVE PERSONALLY E%AMINEO ANO <br />AT <br />O <br />S <br />BM <br />TTED <br />ERE TELEPHONE DATE <br /> <br /> <br />J <br />C ~ VtYZ I <br />N <br />U <br />I <br />H <br />IN; AND BASED ON MY <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE <br />, <br />, , <br />, <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE <br />, T <br />J '" S . <br />POSSIBILITY OF FINE AND IMPRISONMEM SEE IB U.S.C. § 1001 AND 33 U.S.C. SIGNATU E OF PRINCIPAL EXECUTIVE -~I ~I Uv u <br /> <br />TYPED OR PRINTED § 1319. (Penetties untler these statutes may include lines up ro S10,000 entl or <br />maximum impdsonmen(ol oetweenBmonlhs antl5yeors.) OFFICER OR AUTHORIZED AGENT R <br />NUMBER <br />YEAR <br />MO <br />D <br />wmmcrv I o r.rvu r~srttlrvn I Ivry yr ,vrvr vIULN I wrv~ Inererence an artacnmenrs oars) <br />...~ .....'; F:,h ::'i iFCC~~~ri. F:T }E~Si.'I': ~! .fTFpII?Y C[r~24A7:Ch~ f: 11 :,EFtE~~", ~FCi17h 6 FEFFCCLC'IICb <br />~V. i•IYn':'iCF:, n_ "ICYIC 3TY". hi'T iCi. E.. .. £tfL .',? MhICh .°I.'+i I~:ICdLIi °_:f(~It Cit} L[;ilEk! 7F°-i E CCf•TFCL <br />:.S L'_J IIC \/' 9l Y r P411 Li'T +r : 1'.. T 1[, '1 6 ~ T ('(' r 11 [ Ir 1'_ - p?•' f ~ L /' Y EI' Y • C C" i ~ 9 '! 1 M ~. <br />EPA Form 3320.1 (08.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) C C 17 : / C C C ] ] I ~ I t i s PAGE ] OF <br />