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PERMITTEE NAME/ADDRESS Qnclude Fociliry Name/GOCation ijDgerenq <br />NAME ;s <br />ADDRESS yr p r ., r .• : ~.; c' 1« i L f Y <br />FACILITY C ~ r- - ~ ~ = J 31 '' 2 h <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHAAGE ElIM114AT10N SYSTEM (NPDES) FDrRI Approved. <br />DISCHARGE MONITORING REPORT (DMR; <br />s <br />z~'e1 <br />' <br />~ OMB No. 2040-0004 <br /> r m- <br />l " <br />' <br />^ ~ ires 06-31-98 <br />roval ex <br />A <br /> p <br />pp <br /> <br /> PERMIT NUMBER ,~, DISCHARGE NUMBER c - ., .. ~ ~ M,); R . <br /> <br /> MONITORING PERIOD ~ • ' `I 1 ~` T n : T C q. f R ° ° °-1 ~' r <br /> YEAR MO DAY YEAR MO DAY ~ <br />FROM 99 DII 71 TO ~i~ ^, t, Tn ... •: •, .I <br />h ry v crNARrc i ( ~:r~r. <br />I~o-zn rzaz3l rzaz5l 2azh ezazal raoa+l NOTE: Read Instructions bef ore , Oglpleting this loan. <br /> (3 Certl Ony) QUANTITY OR LOADI (a Cem Ony) QUANTITY OR CONCENTRATION N0. PREOUEMC SAMPLE <br />PARAMETER 46-53) ($4-61) (38-45) (46-53) (54-!17) EX OF TYPE <br />(37a7) AVERAGE MAXIMUM <br />ITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />(r,zml ANa-YSiS <br />(84-s6) <br />69-70 <br />~7L rqN^ ;dFAS,^ SAMPLE astR^s'^ ( Rrk+`^'~` <br />V I : '1 A 1. MEASUREMENT <br />p.U UGr+ I .'1 7 .~-PERMIT OQtRP4R- ~ <br />; <br />`,;b - r j ~ #$lfis44 aA#iX:rfi tlC~~ 2i- <br />rFFLII°NT '~7n^c VpLr'r .AEOUIREMENT , <br />~ <br />-~!. <br />~C ~_ ~, ~`'~" :,, :. <br />+ <br /> ~ v 9 ~ ~. _ ~.,.. ( <br /> SAMPLE <br /> MEASUREMENT +w' <br /> i. ( - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMI T,., <br />', `' . <br /> REQUIREMENT „~~•;; <br />I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ . t <br />~ <br /> REQUIREMENT ~`.. >ti`=i , • <br />'.w <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ <br />; .~.~ - <br />~ <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. "';~, - rfi- - <br /> REQUIREMENT ~ ~ - ` ~`i <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT- ~?'~~ - <br /> REQUIREMENT ; ~~~' ~ ` s a* _ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF <br />ILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY ESAMINED AND <br />AND BASED ON MY <br />IN TELEPHONE DATE <br /> <br /> <br />Richard Mllls <br />INQUIRY OF THOSE INDNIDUAL <br />THE INFORMATION, I BELIEV <br />S IMMEDIATELY gESPON <br />E THE SUBMITTED IN ; <br />SIBLE FOR OBTAINING <br />FORMATION IS TRUE, , <br /> <br />/ ~ / ~~~~ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT <br />T <br />`"' '' "' <br />712 <br />97 <br />870 <br />7 <br />28 <br />99 <br />Environmental Manager PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING <br />HE 0- -2 <br /> POSSIBILITY OF FINE AND IMPRI SONMENT. SEE IB U.S.C. 4 1001 AND 33 U.S.C. "SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED marirrw~mlim~smmeM ar OeMee <br />p neB rtanl e~5ude tines up ro 5+0,000 end a <br />yeas.) OFFICER OR AUfHOR12ED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell afrachmenr5 here) <br />:;iT'?L°A:+~} '%:1Lrnc TT"_: ;%IP-''. F^7 >l0Y'e ~t!'1N ;--,frff hV oq1•_^o°_'.^. ~~ T,r r...r ~.,- ~. r... ..~l. •TvgTe. nr{ <br />,:u L.AS° ,r A.r iM1. n1 ~~~ A!:A).'!"Te ,r1T p..0 TF VT~Tf!f.c SF°FN re (lna eor rn~ •.rn)v ...nT T•. Tpa..p.tC';'InN i-T. ."i <br />EPA Form X020-1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) ^ ^ ^ T T / Q h n Il + PAGE OF <br />2-7 52? <br />