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PERMI AME/ADDRE$$ (/ndude Faciliry Name'Loration ifOr$erenq <br />NAME <br />r ,~t..)t; cvnrp" r-(1 (>L'~eT~TI ]sJ <br />ADDRESS- P.. ~, I. ~ _ ~~. i ~! .' r• ~ v p T. cY <br />FACILITY ` F 4 I ~• C'' E'+ 1 F 15 <br />LOCATION <br />hTl'ti: h~t:G' 't Tn• r. <br />F <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMfl1 <br />(2-161 ftr-1B1 <br />^nn ~~ T• ~ <br />PERMIT NUMBER DlscluliGEr+umeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 99 DU DI TO ~ ~ ""' -'` <br />(20.211 RA231 (24251 (26~2I) (29~2B) (30J IJ <br />Forth Approvetl. \ <br />OMB No. 2040-0004 <br />' ' ' ~ ^ ° Approval expires 05-31-98 <br />/^•Trc yq1 <br />-,~~a 711 rAl_n!p +n YtMD4 ,,. •l-. <br />OOR~MD nT aCNAgr, F. I I r:".? <br />NOTE: Read Instructions befor C rtapleting this form. <br /> (3 Card OnyJ QUANTITY OR LO- G (<CerU Ony) QUANTITY OR CO~(,CENTRATION NO. FflEOUENC SAMPLE <br />PARAMETER (46-53) (54-8 rf 38-45) (46-53 (54-Bi) EX OF TYPE <br />(32x7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS avaLVSrs <br />6lY70 <br /> (sz-ro) (Ba68) <br />D(! SAMPLE '~;w~C rn;s ;; p•r :t +`¢yrt •: ( T O) <br /> MEASUREMENT <br />^0%JI?(1 1 (t !1 PERMIT 4,T>!F4R0 0!Otap09r ^~^C CLt:tR$$ '`-- <br />=. ~ <br />i <br />x"t - <br />~~~r / <br />,riles <br />kPFLUk.!%' ;n1n•- VTTIrT REQUIREMENT Y,:Lt00 N • nt# ~n ~%` ~~`. <br />~~rLll•ie c;. T•rr,c+'1 ~' SAMPLE :i •.r~: ^: := .',:i .~~~: O#0::.-.. r 1P~) <br /> MEASUREMENT ' <br />UJ5'!5 ~ 7 '? PERMIT RCY CY tk'JA 04Rtr00 t":? + r., <br />c F F I, +J P X'.° y 4 ~ " ~ J e ! • ~ = REQUIREMENT -~:." - <br />177E ~ Gc~/.5°. SAMPLE .^t1 ,^r-~: ,....ZQ {-0....... TO <br />( , <br /> MEASUREMENT <br />~JO~~h I D PERMIT RtT4tRAr0 049OOa `•:, h0149 ~_ JrgTb ;" ~ 1~~'~~~ '~~~ <br />FFEI.iI°"T :Pn."; VA 1,•'t. REQUIREMENT ~er:•.~ <br />.:".. <br />~.,., .; <br />`"„`n #' <br />..- <br />1 <br />. <br />, <br />~L::we IN. Cat: n17IT 7F. SAMPLE .-.. <br />r y .: n T P : ~ .> . - r T ~ ~ MEASUREMENT - <br />SUIT••n I ^ .) PERMIT ftP.l3~i9i' R£PD6^' q[,rRbtsr: Yehrit~dQ htr84R~ ~~ RT'ej ?14'~'k <br /> <br />`:FrL7FNT .oUcr V5f arc <br />REQUIREMENT <br />0 ~r <br />~ <br />„r•,~ <br />Y . <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />£ <br />~ <br /> REQUIREMENT " <br />` <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT x <br /> REQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT: " ", <br /> REQUIREMENT ~ - ! <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSO <br />AM FAMILIAR WRH THE INFORMATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY TELEPHONE DATE <br />kichard I~lil$ ; <br />THOEU INFORMATION'NI IB~EVE IMHE DSUB ITTEDP NFORMATIONO STATRIUE, ~ <br />/ / <br />~ / ~ ~ <br /> <br />Environmental A18nayer ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM <br />PENALTIES FOR SUBMITTIN <br />FALSE INFORMATION <br />INCLUDING THE _ <br />/ , <br />~ <br />/ ~^}~ <br />97D-87D-2712 <br />7 <br />28 <br />99 <br /> , <br />G <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. 410D1 AND 33 U.S.C. v <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED mevimuni~pn's~wmem of DeASeenU6 meomht ~tl5ude (nes up Ip trp,DOO and cY <br />ymrs.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />A`''PT LF aPL(; :7LIi/5 IIe'I" Yg7YY.'1 P!lP ~1 OYP.~,°qyo Fo G•~Tp c'y v,V T_r-c^ r~n~Te 7r rye F'~A oT•~TTTparr r.~T•G~ nrT <br />G3c./,5~ ;: 'r. f," SA"PLY Ar!ALTSIS Rr'.^IIIt'J TF V:"T9L^ Sp^r•j Tq (+a'.~nP~l, •.nTaLi ~-~"^'.7'+G 7vc•po')CTI^': '•-T.'-.". <br />EPA F`o~m 3320-1 (08.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />n~±~1n/4'1rnla-~~~~ 1 <br />