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PERMITTEE NAME/ADDRESS pnclude Facility Name1[«anan ijDiBerenq <br />NAME•- <br />CTD,I,, v.T, ,. h,..J,t~a,,,,t,. <br />DRESS t-f. ,i..' ^rT.; t''••~r.m(re <br />p. J. R'1 Y h ~+ <br />FACILITY - <br />LOCATION <br /> <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISC+ZA6fGE MONITORING REPORT (DMR~ <br />p r- e) <br />^'tn^T+117 MI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 74 n5 ~7. TO '+~ ~~ t^ <br />/zPZN rz1-z3) rza15) ~_ rz&z11 rz&z91 r3D311 <br /> <br />/5'toD +: ~:) <br />Forth Approved. <br />OMB No. 2040-0004 <br />Approval expires 05J7-98 <br />`NOTE: Read Instruc[lons belor' (feting this form. <br /> (3 C1W OnyJ QUANTITY OR LOADING • OnyJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (9B-53 54-81 (3845 (46-53J (59.61) EX OF TYPE <br />(32J7J AVERAGE MAXIMUM UNIT ~ MINIMUM AVERAGE MAXIMUM UNITS <br />' aNALYSIs <br /> 7831 <br />r6 (B9-saJ 69-70 <br />SUIfDSr ?;1TA1' SAMPLE -.':4 )Ix r~::a¢ rt': t-... .. f 'q) <br />11: '; I? L V ~ r+ MEASUREMENT <br /> <br />702'1 `> 1 - PERMIT ?2t40Ee 4' <br />^ p;:.; ~'+fich{eb 4C!+T}k Z' !~~ fi(4lq~j, •*:~ ~~~.~- +~~~ <br />..r...~:..~," ~u~,-,- .fir,(^I.: REQUIREMENT ~T=; 0146G r1ATlt ~~n~t::j .w .:. if #IAa ,..-~ ~;~"~f "" <br /> SAMPLE <br /> MEASUREMENT t^ <br /> PERMIT - '~*= '^ . <br /> REQUIREMENT - " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT " '.e 3 , <br />x. <br />,y "" ~.~:.'('ry ' <br /> gEQUIREMENT , <br />, <br />_ ,~.~,' - ,~ a <br />~: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;4h~; :=^ . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~- "~ PERMIT <br />" <br /> REQUIREMENT "" ~ - j ` , r .." ..~.;;. ,• <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT <br /> REQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br />~ - - r 's~ s; <br /> REQUIREMENT . .. ;r.. -: - ",.~", <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIOAR WITH THE INFORM LAW THAT I HAVE PERSONALLY ExAMINED AND <br />ATION SUDMITTED HEREIN <br />AND BASED ON MY <br />i TELEPHONE DATE <br /> <br />Ri <br />h <br />d Mill INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BELIEV ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE _ <br />~ <br />~ ~ 7J <br />~ <br />ar <br />c <br />s , <br />ACCURATE AND COMPLETE , <br />I AM AWAKE THAT THERE ARE SIGNIFICANT / <br />~ <br />~ <br />!~- <br />` <br /> <br />E <br />l M <br />i <br />t . <br />PENALTIES FOR SUBMITTING <br />FALSE INFORMATI <br />N <br />IN <br />L <br />DI <br />T I ~? ~ <br />/ <br />,. <br />, ti D <br />970-ETU-271 <br />7 <br />ZE <br />99 <br />nv <br />ronmen <br />a <br />anager , <br />NG <br />O <br />C <br />U <br />HE <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1(101 AND 33 U.S.C. .~ <br />SIGNATURE OF PRINCIPAL EXECUTIVE .- <br /> utle //has up §> 510,000 end or <br />/ <br />m <br />m~n~o <br />m <br />M <br />am <br />~ <br />TYPED OR PRINTED axlmu <br />n <br />Or beMee 6 <br />pd years.) <br />e <br />arths <br />en <br />tl S OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.>LT. Lh'A ~; i. :. •; '7Lrn~ 6I"T° 'dAIYFD car. ~TP'r?, 27,`In na s•rrn _qrr T. A. ~~ ~~ .1rr cam. r-•. -'.. :-.;T~ ..Tr , <br />~: %'~: A.SF: :~~+aR SA"r'1. .° AHAI,TSTS °f: ;)UT°crt T~ 4T`'j'Lc occr-u rr.- r,-^cnL'vP. rT r•mnTr ~p r~1,T•.r T.~'-m a:+('^Tn NS <br />-1. ?, <br />3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) n ~'1 F• p / `! ~ n it ~ ; -] 5 ; ~ <br />.: yt <br />PAGE OF <br />7 <br />