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PERMITTEE NAME/ADDRESS pnclude Poci4ry NamdLocafian iJOifferenq <br />' NAME ;•y:, ^...,T~i. f 7ii''7':14TI ~V <br />ADORESScAI';,; .TV.. °'~"ULny <br />FACILITY `WAIF 'r7 A1A26 <br />LOCATION <br />i <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ Form Approved. <br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040-0004 <br />!2-fe) pn el •. T .~ ~~ • Approval et<pires OS31-90 <br />rnn~~bt n-t r n e /gn'tq .•',i) <br />PERMIT NUMBER ~ DISCHARGE NUMBER ~. _ ~ . q f t " ~ r• T <br />MONITORING PERIOD 'I~/rt 't? f,p-9?.V T^ YA'"t't~ FT"~-' <br />YEAR MO DAY YEAR MO DAY <br />FROM 99 nU ^ TO ~e ^f, Tn RC4 M:) nT C!'u r. ,~•~~. ) I ''F''` <br />„~ .e.~~ ,.,,.,,~ NOTE: Read Instructions befof leting this form. <br /> ,, , <br />(3 Cerd Only) QUANTITY OR LOADING <br />Onry1 QUANTITY OR CONCENTRATION <br />NO. <br />FREOUENC <br />SAMPLE <br />PARAMETER (ae-s3 (5a-s r) (38-a5) (4G53) (54-61J EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS ~ MINIMUM AVERAGE MAXIMUM UNITS <br />tsz-ss/ aNALYS/S <br />(sa-se) <br />6370 <br />JIL 0.':D 1•F4'.'. SAMPLE rs t:C45R 1 9 .. .. ;. .,;.,,. .. ~. ;, ... r,•, <br />V I S J A [ MEASUREMENT <br />, <br />H NU'. F. ~ ~ ~ PERMIT 4Pr.'XRp~ ~}Ts :.' <br />~' <br />~ <br />'=1 Rhitdx.. nx/t rind 40;I„ <br />r: <br />~ 1FGP./ 15~'.~ <br />r F f :. ~I c "' :'. f+ ~ S ; C A T. I I s iiEQUIREMENT „ <br />' ~ --' ~`~ ` r5 ~ _ .y { <br />~ <'. s~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ` <br /> PERMIT:": ,..,~ - _ - .` _ <br />- - k" <br />, ' <br /> AEQUIREMEN7 ; ~`~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REOUIREMENT ^ ; <br />""=,r'~' r ;.al"` <br />~}~j'r Y.°: -~ - <br />I :,.d++ - - <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br /> PERMIT "~ ~~ `'"'- - - <br />~ - - <br />' <br /> REQUIREMENT ""~- a <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ' ,.}3A p <br /> REQUIREMENT ~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - .. ,,,1,. -.- <br /> REQUIREMENT <br />z . <br />- <br />,- <br />__~ u <br />` `~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT a;~ : _ <br />REQUIREMENT '~-`. } r <br />~ .-'~"" - ~ '" <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERS <br />ATION SUBMITTED HER ONALLY E%AMINED AND TELEPHONE <br />EIN; AND BASED ON All' DATE <br />Richard Mills INQUIRY OF THOSE INONIDUAL <br />THE INFORMATION, 1 BELIEV S IMMEDIATELY RESPON <br />E THE SUBMITTED IN SIBLE FOR OBTAINING -~ <br />FORMATION IS TRUE, / 1 I <br />97~-87D-27)Z <br />' ~ <br />, ~ <br /> <br />7 Z$ 99 <br />Environmental Mana er ACCURATE AND COMPLETE <br />PENALTIES FOR SUBMITTIN I AM AWARE THAT TH <br />G FALSE INFORMATI ERE ARE SIGNIFICANT „ /, y •~ <br />/ <br />j <br />ON. INCLUDING THE .. <br />POSSIBILRY OF FlNE AND IMPR ISONMENT. SEE t8 U.S. C. 5 t001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL E%ECIITIVE <br /> 000 end a <br />nhies antler Ness sleMes rosy Inclutle lines up m 510 <br />4 13t8 <br />P ZE <br />AGENT <br />HO DAY <br /> , <br />. ( <br />e RI <br />D <br />OFFICER OR AUT NUMBER YEAR MO <br />TYPED OR PRINTED meximum/mpnsrnmenf olbeAwen6mpn0u end S years.) <br />COMMENTS AND EJ(PLANATION OF ANY VIOLA I IUNJ (nererence au enacnmenrs nero/ <br />r Tor r vI* ti Ge rrl C') ) et"G 71 'r .'f D Cr•T^ G`q n_a CC T~ ."1 roc .'T9 "4c•(~r. r)T ~ <br />:iE.T~.LEA?L. °71. I ~ AI I~,a ,_! ~ "1 . , <br />I'nG'ASE ;Rh[` g0.v-.Lc pKP.'.ISTS r•: `'. ,71fI u47 I° ^I- .Lc rarfG Sc r~o~^np>t.. -, +. rl.v 'e„ ".' ,il._., ^fli?'T'~"!q_I.^.Z• <br />EPA Form 3320-T (OBA5) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />nn~Rq/°~+1n12-1t~' <br />_ _ r - <br />