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PERMITTEE NAME/ADDRESS psddr FsedgAs..YLxsnan l/D/ps..,0 <br />NAME {~ <br />ADDRESS ':~, {1,K 'C"s, k'• [ ~Gt v-/~. L <br />•., a»~_ n \ <br />~3~1 ,krZ LAI /O a" Vr. ~I <br />FACILITY ~ T~ o Q yr u ~~.~ ^ ~ V 1 11 < '_~"'~~' Y N <br />LOCATION J Nr `~ ~ IL: N.nc <br />•"~: )N <br />A.l_. ISL., y ~o KID91 <br />NATONAI POLLUTANT DISCHARGE F1IMINATIOH9YSTfM /NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />!I-151 I7-19 <br />nnr nn <br />PERMIT NUM ER -yam DISCNMGE NUMBER <br />4lTl MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 0 IT TO / r) <br />/J0.Jf1 tlAJil rJLJ /J6Jll OA-JAI /i/1.911 <br />Form Approved. <br />T y i, O~ No. 2040-0004 <br />Ap ovel blipires 05- 1-98 <br />(':I!il y{ gT,) t:?III', <br />F ~'PT"4I <br />Y7.., <br />NOTE: Reed IrNIR1C11gMl 6e(orletinp thb form. <br />PARAMETER 13 Grd Only QUANTITY OR LO /I brd On/yl QUANTITY R CONCENTRATION NO. FREQUENCY SAMPLE <br />13I-37) 14653) (51-6/) 13B-151 !1653 51-5/ <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM 17S MINIMUM AVERAGE MAXIMUM UNITS /aJ.eai ANAlrsls <br />/5¢581 /59-701 <br /> SAMPLE <br />MEASUREMENT =.`R RCC: ,, <br />R^RRC^: <br />..r: <br />:~"OE¢ <br />( lZ~ <br />1)11'1 !~i) 1 D ') <br />. ~ ~ <br />... . PERMIT <br />REQUIREMENT : RR GG¢ ~. <br />~ ~: t~-i~~C.¢¢ <br />: <br />~ R_~.: :6 r~g. ~ ~. ¢~;I.w.'.1 ^~. +:" '"~~. Q <br />~ <br />~. 'TCR I. <br /> <br />[ <br /> <br />dY`' <br />rT"•' <br />. <br />,.. ~, ,; , <br />r v <br />: y : . . <br />. <br />~ .» . <br /> <br />.., ii 1. !."";, r~Jrsl. SAMPLE .,,..> rtrra:;:-; <br />- <br />¢4 ¢>tr3R ( T 1~ <br />~~•)'J„T'..![?`:J MEASUREMENT . <br />)Oy 47 I U f. PERMIT.:.:::.:. <br />~ : . D¢: P~¢ <br />.: ': O:.R4 R^^ <br />Q#~~ <br />~ <br />31 ~~ <br />7D <br />'!iii <br />/ <br />.kAR <br />I. F v 1 -.. T r I, .REQUIREMEN~ <br />.. <br />:, . <br />~ . <br />: ~ . <br />f N)::, T'?1'iL SAMPLE RR RFRF ;'--:/^::-^ <br />~' r-.G4R¢¢ ( 1a) <br />(', . F°1 <br />MEASUREMENT <br />I <br />~. <br />ii: 1JQ S i D U 'PERMIT <br />RE .~K%#LL p~p:.<:'. <br />~ :~ Sr ¢stir ¢~TX ~ <br />IR 4Ci0~~ ~~~ <br />~. '3 J, U ; <br />: V('i:/~ .q Al< <br />F' `' t N T• f~. QUIREMENT <br />: .....: .. . . . <br />• . <br />ICL .4 )1 f~ ':!!F:ASt SAMPLE ,~f-50r¢ RR;:.^-,• '-~t r'~¢¢ ~nr Cr': ( 19~ <br /> MEASUREMENT <br /> <br />!S`.'+1 I D D <br />PERMIT <br /> <br />R ,. <br />;<:gg~(kCr::r' ::.,:: <br />:::' ;fGxt=GC <br />r:::- <br /> <br />...., ^....:w <br />~ . , <br /> <br />~. <br />~ ~4CI~#1111p' ~ <br /> <br />... <br />`~~~ <br />~ ~ <br />~ <br /> <br />~ <br /> <br /> <br />Tl'l T T <br /> <br /> <br />R ~ ` <br />' <br />-.) , .. EQUIREMENT ,. ... <br />:. <br />: <br />~ . <br />: <br />~ . . <br />. <br /> . . <br />. <br />: E]4T <br />f' L:-, 'i . I '/ .^ 1 M D II I ^ ,~ }/ SAMPLE ( ')f1 `..^.` .^rr.^;:o czt;:.~.. <br />,,,; <br />loll iF'':4T9°N[ ?'LtV MEASUREMENT <br />'i p' I'.I J ! J '1 PERMIT ~ n v.p .,. <br />::..~: <br />URt .,. , <br />.?~ <br />::~RF,?OR [' . +.. <br />f:.:`r.; ,. <br />,...SO.xG <br />:aRr7~~= <br />::Y ~: .^ <br />^?>{1 <br />Y <br />TNSTAT <br />.. I. , <br />L 9A REQUIREMENT . <br />~: . _ . <br /> ; . <br />~ ,~.. <br />~..+IL ?e, l~ .;;t F.RSE SAMPLE ~. °~P¢ <br />( .~U~ <br />~ ~ ~ <br />.~'. ~~~."~ - <br />~~ ~ ' <br />Y 15::^I. <br />MEASUREMENT <br />-,'/J'In 1 D l <br />~ Ram prtr?F"':`~ <br />" ~:::RE PURF F":-1 ;:; .a ;T:.:x :.^4'-::3a ~r:ri~i:L ti..,y <br />' rcc•yY 'TSIIAi <br /> ~ <br />REQUIRENIENT ~ ~ ~ ~~ ~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> :REQUIREMENT <br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNQER PENALTY OF LAW THAT 1 HAVE PERSONALLY EIrAMIN <br />AM FAMILIAR WIT <br />T <br />E <br />M EO AND TELEPHONE DATE <br /> <br /> <br />q <br />~ <br />. H <br />H <br />INFOR <br />ATION SUBMITTED HEREIN; AND BA <br />MY INQUIRY OF THOSE INDIVIOUKS IMMEDIATELY RESPON9B <br />OBTAINING THE INFORMATION <br />I eEl1EVE 7HE SUBMITTED INFORMA SED ON <br />LE FOR <br />TION IS <br />r <br />~ <br />e , , <br />'~ , <br />TRUE <br />ACCURATE AND COMPLETE <br />I AM AWARE THA7 TNE <br />RE ARE ~ <br /> . <br />. <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INC <br />LUDING ~ ,r <br />~^ <br />h( A ,, s. n / , <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE IB U.S.C. L 1001 AND SS N <br />~ Q ~ / , 1 r, ` ~ <br />TYP D OR PRINTED ~~ (MWMa unssr Nsr mllma mry McA/ds furs w ro ! 10,000 B <br />ATURE OF PRINCIPAL EXECUTNE <br />N <br />B <br /> Ms w ~ <br />sdsasrlrrt e/bM«n emm/haAM6ywA1 OFFICER OR AUTHORIZED AGENT CODE UM <br />ER YEAR MO DAY <br />.._._._ ...__ _... ~.. _,..._.- _. ..... ..~~ ................. o..... ~,, e,.e~...,.e.,.., .....r <br />f;i C.AT .}y:l,pr? fq uI°.+°;^ "')NT"L[ lIY:. ~1)?IN^, ?r:Rl'"• °n~r ••: n, '?IT, f'kE,.`~:'' rp~ T.°.TS'IF ^. ~. <br />EPA Form 3320.1 108-851 Pre~ioue editions mey be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 PAGE OF <br />oon1D/96.1(7:3-tzzi <br />