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PERMITfEE NAME/ADDRESS (Include Facill y NmndLxnrion j Differrnrj <br />NAME.t"'I:YPH"~ ~ v;,: nG- rnpP7u ~ <br />d.I~N <br />FtbDRESS :, h ; ~. .`: " T q -~ ^ p M p I, c••( <br />C~4I.~ 'n PI~,7r, <br />FACILITY '" <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMq OMB NO. 2040-0004 <br />Approval expires 05-31-98 <br />rnnn~lvl~ n c • (~nqy ry~ <br />PERMIT NUMBER DISCHARGE NUMBER c _ t• T .' q t .•'~ 1• r <br />MONITORING PERIOD °"'t° 1l r~• N-`01 ;: T^ =TT I T' "' °°`' <br />YEAR MO DAY, YEAR MO DAY <br />FROM 9~ ^G TO ~' ,, '" ROD{ ND DTSCN6°"r ( Yr~;: <br />rzazll fn-xal r Izrrv7 fzBZ91 (3o-sf1 .NOTE: Read Instructions betor IeGng this Corm. <br /> (3 Card Onyl pUANTITY OR LOADING /4 Card Onyl GUANTITY OR CO CENTRATION NO. FREOUEN SAMPLE <br />PARAMETER 46-53) (St-sfl (3e-45) (46-53) (54-sf1 EX OF TYPE <br />(32,37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />6&70 <br /> rszsl) 6a-sa <br />OLDS, T'%r4L SAMPLE 7~k:YrOr: rt;yg,... rtt4~Yr~t ( 1`1! <br />~I'3'DLV~ ~ MEASUREMENT <br />7U2"5 1 U 7 PERMIT R4+SprYpl r,.C'~ g - ''' A~'l'f3!!• ~ <br />'P}`` "~ TF.I.Y $A!l <br />> <br />k'PFLL'Fti? %'!t n:45 PALr!t ~REQUIREMENT ~ ;.. ..., y140O .~- .. n4T3+ 4? I <br />!4! "i'./1 . <br /> SAMPLE <br /> MEASUREMENT ~.. <br /> PERMIT <br /> REQUIREMENT - :~; <br />.~*~ ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT =" ` ` <br />. <br />~ <br />- <br />- <br /> REQUIREMENT p ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT w mss, s' ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT- <br />- ~ ::,;M,~, ;.:. <br />~~`~$ <br /> REQUIREMENT : ° :~ ; ,a' -' . ~ <br />'' i - <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT ,.. ..~ , ,. <br /> gEQUIREMENT - ~ <br />.~ " ;:P.'~ <br />-> <br /> . <br />y <br />, . <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT: - .~ ~ ~- . ` ~ - - <br />- <br /> REQUIREMENT - - ~ '~- ~ ~"' <br />^~" ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM lAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E](AMINED AND <br />IN <br />AND BASED ON MV <br /> <br />~ TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL : <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ ! <br />~ <br />Richard Mills THE INFORMATION. I BELIEV E THE SUBMITTED INFORMATION IS TRUE, / / '+ <br />~~~ <br />/ <br />E <br />l M ACCUMTE AND COMPLETE. <br />PENALTIES FOR SUBMITT <br />N I AM AWARE THAT THERE ARE SIGNIFICAM <br />RMATION <br />INC <br />UDING THE <br />G F <br />SE I <br />F ~ <br />~ <br />,~ ~~ <br />` i/ 97O-S7O-I7IZ 7 2H Q9 <br />anager <br />nvironmenta I <br />AL <br />N <br />, <br />L <br />O _ <br /> POSSIBILITY OF FINE AND IMPRISONMEM. SEE 1a U.S.C. 6 1001 AND 33 U S.C. SIGNATURE OF PRINCIPAL IXECUTIVE <br />TYPED OR PRINTED mwrrw~mLPo~~rurrerrt ar t~~ Rfiut~I ~IncSUde lines up ro E1D,000 erM a <br />P Y~J GFFICER OR AUTHORIZED AGENT NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell attachments here) <br />~;;TP LE; F.HL'c q~t rr- r,T vrn .nIIGF POP ?l Q1u, ,It :i7 p., .. r-Tn ctT 1•V'r_~c': •. a.lr f•~ r...r ^~o :,c~nlaFrcpTe~ nTr r <br />::RI'.45E v:!5f. g6YDI. r' R`: *.!.Y ;T$ Ycr+UI P$!1 to YT~IPLc ~v:uN I" (1°`~vcq°(~, r1$o..r ./ ,..~~~.-r ~~;G+gll['^T^V;_T.^,^ <br />EPA Form 332o-T (08-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF <br />nnn~7i~nn417-1523 , <br />