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PERMITT E/ADDRESS pnclude Faciliry NamdLocarion i/D$erc~q <br />NAME <br />.,,n~ ^r pr uc~ r0^n l'f~TI7r: <br />ADDRESS • 1 ~~ r r ~ T u r ~+ r p 1 Fv <br />FACILITY C L, 4 r ~~; ~~ 91 F 24 <br />LOCATION <br />ATT'1: ACS^P°f' Y+, •, <br />NATIGNAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPOES) <br />DISCZARIGE MONITORING REPORT (DMR~ <br />n 7- 9) <br />r~r. 'r rTn~ n+c <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 7 9 n ~~ 7 ~ TO o~ ^" T" <br />(20.21) l22-231 /24251 f1B-2]1 !2&291 (30-31) <br />.~ ~. <br />(cnn: ',1 <br />Form Approved. <br />OMB No. 2040-0004 <br />Approval expires 0537-98 <br />" Cuff! ~~:+.. <br />.. .. ~,4n.-c t --•.. <br />- . NOTE:~Read Iristructions befo I feting this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Cab Only) OUANTIT1(OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (5I-61) ~ (3815) 4&53) (54-6/) EX OF TYPE <br />(32)7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />ls2s3l ,wal.YSls <br />(64-6a) <br />69-70 <br />C)IL AN1~ :rEASF. SAMPLE .... , . ( . . tia ,~,. «...., .. .; ,...;. <br />~~ I :i ~) A L MEASUREMENT <br />NUJ',b 1 ~ D PERMIT CSs t•C*+a C r"=T ~,~~RI~_,. alQ itA4lk GRd+'+rM+! ,.. !V^f'/ j~')ff~:.. <br />F: F= L U? t: ?' r F 7 S S Y II (. I' I REQUIREMENT T N a >]"_ ^ •. M k T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - o- - . <br /> REQUIREMENT j <br /> d <br /> SAMPLE <br /> MEASUREMENT <br /> ;:.~-PERMIT <br />m k s --: ;. <br />-. <br /> <br />' <br />- <br />. , <br /> REQUIREMENT ~.;., ;t ~=±ea t ar '~`. :4 '= I .4 ,?.. .- <br />,• <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ..^--°,~~: .~-- ;,, -- - ..: ~ - <br /> REQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> ''-.PERMIT ~~- <br /> REOUIgEMENT = s{ er'`~ . - - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,' t .~^-• -. *^.a.~ - .. , . ,...- . <br /> REQUIREMENT - -~~`" ti;#<;„~ 1-; f <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ <br />)'*: : ; <br /> REQUIREMENT ' ~p <br />'!~ ~ ~~ <br /> . ,, . <br />~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND <br />Y TELEPHONE DATE <br />Richard Atllls AM FAMILIAR WRH THE INFORM <br />INQUIRY OF THOSE INDIVIDUAL ATON SUBMITTED HEREIN; AND BASED ON M <br />S IMMEDMTELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE. / / <br />' 970-a70-Z7~Z ~ 28 99 <br />Environmental AAena er <br />g ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICANT <br />O <br />UDING <br />E ~ r _ <br />J/ <br />' ' <br /> N, INCL <br />TH <br />PENALTIES FOR SUBMITTING FALSE INFORMATI <br />POSSIBIUTV OF FlNE AND IMPRISONMEM. SEE 1B U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED rll(1YlmBml~p/150 TB/1I f) burxsenroB~monf/tt B/1 Sluff%nes up ro 510,000 ontl or OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all ettachmenls here) <br />. ,:iLEA''.L;. ['1LI"r T..T"T" s'4T~`F^ F'!)P ?1 .'TYUe: 9'!9 o?C('T^ ^P eN?-i1"' T. TA P^ Tye ^~t~ p~ri.:r~jCYC11T~ <br />nr1 <br />,NP.95: i;dAF '9""fr A':ALY ;[`% 3';!17 PP!) T° 7I Sj ~(.° cpc=V 1S [fn-rr~:f er;~ nn+~pry ~,. ..^ <br />I T^r T. ..nrr(-T j'l `lam-T. .~ <br />3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />Q0967/9'1 ^ rtl 2-l s? l 1 <br />