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PERMITTEE NAME/ADDRESS (Inolude Faciliro Name/Gocurion rjDipereno NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ FOfm AppfOVed. <br />NAME 5 E N ECA CC A L CQ C F J N I DISCHARGE MONITORING REPORT (DMR; <br />(z as) Or s) OMB No. 20400004 <br />YI dGd <br />ADDRESSDHARER D <br />d0.( 21 Approval expires 05-37-98 <br />(51/dN N1) <br />HAID6N ', CQ 81639 IT NUMBER ~. DI$,PLAARGE NUMBER <br />~ F - PI F.II FC U''1T <br />FACILITY .. ,. <br />~ ~~""H{T!. <br />r: <br />q:: MONITO GPERIOD DI::iC Hh F. I•E TC HCEEE E~~N GGICN "~° <br /> . <br />, <br />r.a <br />LOCATIO <br />EN <br />MAI ~J. VEAA MO Dq Y , ~ YEAR MO DAY <br />D 630 FROM p ~~ Lt ~u ~C^ NC CI:CNAEEE ~) Lo>a <br />A'f T N : G • b U D B H O M A • L t N ;i F 0.L R rA E N lzosi) (zz-z3 !7 !zs zz) (2e-ze) lsa3+l NOTE: Read InsWClions befo .completing (his form. <br /> (3 Cerd On/y7 <br />pUAN ITY OR LOADING Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER , <br />(4(e5 ). (54-6fI (38-45) (46-53) (57-61) EX OF TYPE <br />(3237) AVERA <br />~~ <br />MAXIMUM <br />UNITS <br />MINIMTlFiT. ; i , <br />AVERAGE <br />MAXIMUM <br />UNITS <br />(szr~T) ANALYSIS <br />(64-68) <br />69=70 <br />Aa $ PLE as ( 4) »a ,.4 an;iO+Clo <br />YI5UAL M ~REMENT -'-~1 <br />tluUb6 1 U v ~ ~ Rua <br />~ ,asl O, ~ {F< '_;~ 0>09 ~- . .33 <br />P.FFLUEpT GHUSS L'ALUE ~ >t~ ,~ j~ 8 ~ ~`'`* ~ ~.~+t~ r "' ~CiiO •'~ <br /> , <br /> SAMPLE.. r <br /> MEASUREME~ =. <br /> -PERMIT ~~,. ~ - w ~ `~~" i~r-~r~ , "~a' A~~ 1, <br /> _ <br /> SAMPLE .' ~` <br /> MEASUREMENT <br /> ' ' ` " ' <br /> lI R6M <br />~[~T r. r:-~ ~ <br />xs ~ >` ~. ka ' - 'tK: <br />~ r k <br />~ <br />~' <br /> , <br />- <br />iti <br /> SAMPLE f. <br /> MEASUREMENT <br /> ~ SR,t ~x~ .. <br />+ k <br />' +~y'° ` <br /> A60UTAEM Ni ~ ~ ~ <br />-,wl <br />- SAMPLE <br /> MEASUREMENT <br />~ . <br /> :~ ~~F~M}T sir ,_ u° j. <br /> <br /> SAMPLE <br /> MEASUREMENT <br />' <br /> ~-~ -'P~AMU'' - - <br />' ~. <br />~~`.r <br />~ <br />~ - <br /> ~RSdUIREMENT .. 'ate f«'S ~ n <br />` <br />'~~ <br /> , . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERE NALLY E%AMINED AND <br />IN <br />AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON ; <br />SIBLE FOR OBTAINING <br /> THE INFORMATION. I RELIEVE THE SUBMITTED INF ORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT TH <br />PENALTIES FOR SUBMITTING FALSE INFORMATIO ERE ARE SIGNIFICANT <br />N <br />INCLUDING THE <br />- <br /> , <br />POSS <br />MPRI <br />B <br />ITY OF F <br />NE AND <br />M <br />M <br />E ~ /\ <br />V ] <br /> I <br />IL <br />I <br />I <br />SON <br />E <br />. SE <br />18 U.S.C. 4 1 OOt AND 33 U.S C. SIGNATURE OF PRINCI AL EXECUTIVE Ol <br />TYPED OR PRINTED meximum~nnsonrtren~rl SeMee ~B mernths entl5ude Inres up ro E10,000 entl or <br />P rears) OFFICER OR AUTH RIZED AGENT <br />coo <br />NUMBER <br />YEAR <br />MO <br />DA <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e/I attachments here) <br />Tss E IRON LInITS Ir]11 BE YAIYED b SETTL£~BLE SCLICS LIEI7 AFFLIfL FCfi C=l0IN,2aEN FNECIF i9ti7= T55 C <br />IHUN LICITS YAIYED FC6 ~1GIE1,24HR PRECIP BYENT SUEJECT TC 8U6UEN CF PFGCF IA I.A.Q. CIL b GbFlSE - SEE <br />s_ a,. - t_ n. T n a M !~ Y i T I~ C i tl C T o i c <br />EPA Form 3320-1 (08-95) Previous"eiiitions may not tie used. ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) QQ }QSII99'd ~ ~ - I6 S 3 PAGE ~ OF <br />