|
<br />PERMITTEE NAME/ADDRESS (Include £enliry NomelLomlion iJDi$erenq
<br />NAME C, - :TU~ rn, ,
<br />ADDRE_SSp-q1", L'' •+T1.- ,1~~,• '""~.
<br />t• n ,~~ r,7y ..1
<br />FACILITY C• r '-'1 '11 A?.5
<br />LOCATION
<br />ATT!:9 AGF.ON^P ;.. ye.';.n Y. ('.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (D(MR}9f
<br />R-16
<br />PERMIT NUMBER DISCHARGE NUMBEfl
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~'i ^'I '`? TO ~`i ^r, ~~
<br />(10-111 R2-231 (20.25) (1F1]) (28191 (3631)
<br />Fonn Approved.
<br />_ OMB No. 2040-0004
<br />~' ~' Approval expires 05-31-88
<br />(~'!~°~ ;I:;l
<br />'1F rT~.o h .rn y,1.1.~1 a- Cln .:
<br />NOTE: Read Instructions before leting this form.
<br /> (3 Card 0
<br />5)
<br />QUANTITY O~ OADING (~ Ceni On-0)
<br />QUANTITY OR CONCENTRA
<br />10
<br />N N
<br />O. NC
<br />FREO
<br />U SA
<br />M
<br />E
<br />PARAMETER 6
<br />e 5J
<br />4
<br />1 C F
<br />O T
<br />PE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANAL}S(S
<br /> l616t1 (69-68 6370
<br />:'ri SAMPLE !•n0?R7 Rx D'•r. ,, ,. ,•.;.+... .. f T ~)
<br /> MEASUREMENT
<br />U01ip(1 T `i ` PERMIT dtldddp ~ ( r:±r, r
<br />*"
<br />~~#~
<br />0 ~
<br />4itCF/ t
<br />ReR
<br />"r'F~LIIi:'!T I.Y~°4 V'1i,a: REOUIREMENT ~x,t
<br />4,It;'~*_-„ d#rtrt k:~S~ ;'_.''. T-rIM ~TnJ6Sa .
<br />S:i;.I^S, 'rT•TLe~ACr.r SAMPLE ~ ~ F^cYC- .. „y
<br />( -)
<br /> MEASUREMENT
<br />t1l;5fl c~ T .I •I PERMIT dIR 9'PETO R9+G9tRR ~. dd'd'ps/4"i;"~ ~~ ~'~` `x .`v'q N"1'/ ~
<br />Sl
<br />'){A,
<br />:' F F 1 11 F •. "1' Iv r :? ° `' '! 4 I t. REQUIREMENT ~
<br />;11 T, l: :Fr. A°C; SAMPLE ;: r: r:r^7C: ~` ~rt +-snyr~~ T T-7)
<br /> MEASUREMENT
<br />Li)ti`.1r. i (` PERMIT #R>dt'#;~. ~
<br />~ ii>-4'R## .<a9ra# 169118#; (Oj r nYrTY' .atn
<br />[ F ~ 1. J ?. tl T !~ rz 7 ~: C C ?. L 11 r REQUIREMENT ^'~ ..W . a-i
<br />
<br />-
<br />. - ~. , Vii" r ~ / c n .1.
<br />P!.'
<br />`1.0;~ Tti ~~Nnnr^ -, I: SAMPLE r T!
<br />( - .d;...,;.,.., y:,A4~.,.
<br />T ft u li T {; r ; ;~ w c r ^ :~. {, 1 ." MEASUREMENT
<br />tiUl}cl^ 1 f• n PERMIT ~~~E}~~ REP'a N'!T '•J #1'X#kt lY: ~;
<br />4#~p ~
<br />~d#~~~' ..
<br />~'nF/
<br />NS'j~K
<br />;.F=LU.^:'•T. C~"1`;' 'Jg1.ISr REQUIREMENT ~ .~ x~3 (~. t Nn 4
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br />~ ''' ""' '
<br />~ "~ ~'~`
<br /> REQUIREMENT ~
<br />- ~ -
<br />
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT - ~"
<br />~ ""'
<br />~
<br />+ ~~'
<br /> REQUIREMENT ,~ "
<br />'.=Fj ;, ~~
<br />
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT zs `; .:...
<br />
<br />' ' _
<br />
<br />- ~ y .., .:
<br />
<br />€
<br />{
<br />i
<br /> REQUIREMENT ~ ,~ ... ~,
<br />. .._., ..
<br />~
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF I
<br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSONALLY EXAMINED AND
<br />ATION SUBMITTED HEREIN
<br />AND 9ASED ON MY TELEPHONE DATE
<br />
<br />
<br />i~ichard 11f(Ils
<br />INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE, / ^ ~ ~~
<br />~
<br />'
<br />
<br />ACCURATE AND COMPLETE
<br />I AM AWARE THAT THERE ARE SIGNIFICANT /
<br />/
<br />'~
<br />~
<br />r
<br />EnvlronmenWl ~7annger .
<br />PENALTIES FOR BUBMITTING FALSE INFORMATION
<br />INCLUDING THE ~
<br />,/~
<br />~~~ 970-870-2712 7 28 99
<br /> POSSIBILffY OF FINE AND IMPRI ,
<br />SONMENT. SEE 1B U.S C. 4 1001 AND 33 U.S.C. _
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED merimum(~nn'sonmerlf ol6enreen 6monfh,~enld 5uda limes up b 310.000 end or
<br />P Yee~s.1 OFFICER OR ALRHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments hare)
<br />J E'~T Lf^. 11 ,°1iC ~1L 1'. 1. ,..Tr Jgl•fcD :'r',q )]pvu -I~y.l ~~.T. ..F :T- ,. -. ~.T n- r1/ r'T •] ~Fnn Tn;~+ro.iTe r•+1 r
<br />r
<br />~9t:ASr 1;vtP 56°ri.' A': Iti.T`TS HE~JINrq Tr ~.,;TFI.° S'.-:,Y i°~,f.n;cnv•. ~ aT^Tv ;)..p1T.~T' T'I`"'"'+r'CTI^N^-T.. °•
<br />EPA orm 3320-T (08-95) Previous etlitions may not be used. (REPLACES EPA FORM 7-90 WHICH MAY NO7 BE USED.) PAGE OF
<br />
|