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PERMITTE~ME/ADDRESS (/nclude Faciliry Nmne/LOCarian jDgermq <br />NAME P5t1S rr,~rrc MK,''7='ATT7Y <br />ADDRES~~CLL r*Nr -ryN PL7y <br />Y.O. P1Y ~5n <br />FACILITY LI1 F.T~: CC `.?1825 <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM1 (NPDES) <br />DISCHARGE MONITORING REPORT (D(MR>BI <br />(246 <br />-~n~T T~ n~ <br />PERMIT NUMBER DISCHARGE NUMBEfl <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 99 OD ~ ~'TO r"' ~~~ 71 <br />(2621) (22-23) (24-251 (26211 (2B-281 (363h <br />-. <br />Form Approved. <br />_ , - OMB No. 2040-0004 <br />• Approval expires OS-3T-9B <br />c - C{~!,T p7PRT <br />NOTE: Read Instructions befor Ipleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (a Cartl On/y) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />~ <br />PARAMETER (ere-53) !5a-e]) (3845) (46.53) (54-61 EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(62-631 aNALYSIS <br />(64-681 <br />69-70 <br />COLI°OR°, ['r^A' SAMPLE ':: K: :.^-R: 64RC^~Y ... .. ( ~ Z) <br />=, \ ? ; p L MEASUREMENT <br />l40S5 1 ~ 7 PERMIT D4tAR1t# ~'~ ~^'' 5091) ! ~(-ITf f <br />IIG~J~` <br />~ <br />°F:-LUF:AIT a°-' ;•; 'In • :~ I REOUIREMENT ..-~ <br />~ ;;~_ - 7 ' D ci' <br />JIL AN:' .:n ~,yr _- SAMPLE ^,. r::'r rtr~ [ <br />~'!) 7Cl1:+¢:` r; rye...,. ,... t:;: <br />Y I S R A L MEASUREMENT <br /> <br />N4Ubb 1 D !I <br />PERMIT <br />R/OtOdPq <br />9 <br />`'^=T <br />pQ"fe" <br />~(t41t b>7n <br />:•-~ ,.r~;€~` <br />.T$vl§.. <br />;;FFLh~t~T ,F7F.5 YALIIc AEOUIREMENT L$S! ~ -~ .11_r) '., ? '~;,~.- ~ ~~- - ~"*~~-_~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIL <br /> REQUIREMENT ' ,'m',:~" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '}' '"~ <br />- <br />I <br /> REQUIREMENT ` <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - . ~_ - j <br /> REQUIREMENT -'" "' "" `'"" "' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `~ ' <br /> <br />REQUIREMENT <br />~ . r'.. <br />- "- t~ t <br />c.r:';~ <br />' <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT - - I - ~ ~`~~, '' - <br />"" <br />REOUIREMENT <br />"..,vim ~`§m„ ", " <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV <br />Richard ti9ills INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />RMATI <br />N IS TRUE <br />~ <br />' <br />'~ <br />, <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFO <br />O <br />.' <br />/ <br />1 --/~ 970-a~o_27~2 <br />I AM AWARE THAT THERE ARE SIGNIFICAM <br />/ <br />ACCURATE AND COMPLETE TIE 99 <br />J / <br />. <br />ElTVlranmental lylana @r <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE ( - <br />POSSIBILITV OF FINE AND IMPRISONMEM. SEE 1B U.S.C. § 1001 AND 33 U.S.C. -' SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED mavmum~~onmerV Olb eneene6 mBant~enE SU~~rres upro Et0,o00 ender OFFICER OR AUfHOR12ED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re7erence ell attachments here) <br />OIL L' CY.'-Acc. ^:..a o6nr,;•., 4FiALYST~ z'OU'OFP i~ VIST9Lr ;ucP4 7° 1nCcgVcn ~^ r;~ ru~n•iry. VAe r;=T+e .: ,nn^r <br />1eNCT° [ND C9L7n7~;c Tat;,;.~e.;rl. ^ T3LY S1M Li"': 7'":T.'7_ `t5-, ~ - •. 07^. IN°L1=*1"' rp•.nf.. ~ ^.r= <br />EPA~Form`93261 (OB-JS) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE OF <br />0^IS7~940~12-15" <br />