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PERMffTEE NAME/ADDRESS (include Faciliry NmnNLoconon if Di$erenq <br />NAME --} -~ . ^ s „ - , .. _ . ..-1. , <br />.. <br />ADDRESS f T '.' . , 1 + •~ : .. <br />• ~ ~ • <br />+. ' • + ^ 'Q <br />V ~ p~ <br /> (~J GIS <br /> <br />FAC1uTV W ~ <br />LOCATION (~ ~ <br /> <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) FOfRI AppreVed. <br />DISCHARGE MONITORING REPORT (DMR~ r ,~ „ OMB No. 2040-0004 <br />Iz-+s) m~ e) Approval expires 0531-98 <br />(7 PERMIT NUMBER DISCHARGE NUMBER ^ _ ~' , r -. , ~ ~ ^ <br />MONITORING PERIOD '~T '~-~ "T^r v. ^: ,. +1 ^nrr\.~T •,~ <br />YEAR MO DAY YEAR MO DAY <br />lzo-zl) (zz~z3) (zazs) Tte-z0 (ze-ze) (3031) NOTE: Read Instructions before fompletlng this form. <br /> (3 CerU Ony) OUANTITYO OADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 46-53 9]•Bf 3e~5 4G53 54-61 EX OF TYPE <br />f323~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~) 'W~ 6g~s 69-70 <br />~. SAMPLE .-.. ~ a~ rsc"': ;.:r _.....: ,. ( ^~ <br /> MEASUREMENT <br />U :)x1711 n 7 PERMIT.: ~~ <br />~~ •;;•• ~ .. ."t' ~~ 51+EQ $#'Q#' ~>11~ 5- <br />~ ~' ,~,'.~".{(.~~ <br />'.1 ~ LL1:: i ^7S5 V4 L'1' ~REQUIREMENT """' ~. >^~^•R (}~~x~~~ ~~5~ <br />~ <br />~ i-1, .. <br />„ ~.~ =€~~. <br /> <br />• <br />': . _ <br />: <br />. y <br />O.; L1 V1~ i ~1 ~. .. SAMPLE ¢r;eh'„!(j C x9•:x. .. ( 191 <br />~ U ~ b °' 1' -" MEASUREMENT <br />r.^,.10 ^ ~ <br />' PERMIT ~ -..vaaae-¢4 .. <br />`~~` awfi+l `n";~ .. ~ _s. <br />e - '~*t -- ~x-~ <br />~ ~ -;4 <br />!l4L T!/. <br />:YF[..a'.':"" .:n7i5 Y^ „"r REQUIREMENT <br />~ yr-: ,- <br />+ . <br />_ . SAMPLE .:. C :: t' .r .. .Y ..:....;.:. ( '.. 91 <br />I'JAf! pE'CJYF[3~-'L' MEASUREMENT <br />,:C"'nr 1 0 ~ pE~ t t ~rti~ PAP <br />~ F TT4 ~;~ :*, fi+T '? <br />a ~(~1fF/c <br />{1 ' GRJ'$5 ''' ' REOUIREI'A `~'+~ <br />;^ - ~=~ I <br /> . <br />~ ' <br />.... .~ yIl A.. SAMPLE ~ ~~.:^:: Crs. ... <br />x-art „ ( ~ ~) <br />C Z S' l1 L Y ? it MEASUREMENT <br /> <br />7 1 } ~ V ). 0 D ~ PERMIT =' p , . ..,., ~; :Y# <br />A 4A1 u." IT. P 73r.;}py~ <br />' <br />:; / <br />~ <br />)Y <br /> Y . .m.. , <br />~ <br />.. <br />... t <br />. _ _1i „4_ Ira l.Ilr REQUIREMENT ~r-tC ~ "?S` i "71I ~'~ "_.T $. <br /> _ <br />~ . -.; - <br />..U'. ;.H, ea v ^[ o SAMPLE `F <br />C^t` x..; ._xx,x ~ <br />,. ,., .. ..:_ ( T n' <br />Di:~SGLY6D MEASUREMENT <br />J 13'J ~ 1 '.f ') PERMIT <br />~' ..,... to ., 9 ~'~~ ~ <br />` '~'`!". ""' <br />~ <br />t; ~. C'C"I^, ~~^;5 VII rli )iEQUI EMENT <br />R - - x' t`xi i=' <br />3f~A4 <br />IIY <br />; <br />~l41f RX ~._ <br />/I <br />af. - <br />' <br />M{lk ' <br />te' <br /> _ f - <br />. <br />_ , f. r <br />., C Ll ., .. SAMPLE -. : <br />7 K.L fiy .~.. .. ( , o) <br /> MEASUREMENT <br />n 3 ~ ~ 2 1 0 '1 <br />PERMIT ^° R 1#" :- <br /> <br />/ <br />: G:tigr fR4--~=t <br />- r.:. .._ <br />~~" ' - ~;,. <br />-'r <br />A~~r , <br />~ !~3 <br />'L'II /. '" .^l,'' REQUIREMENT - ~x j TN$3 yllt <br />' ri L :9M$` y° <br /> ~ : „ <br />-.~., NT.: :. .li <br />~ , ... SAMPLE ': ct .:': 'G ~•r.„^.C ...::,,..~. ( 10~ <br />'C6Y `'^,? ?l. F' MEASUREMENT <br />T 1~ 23 1 L' n PERMIT 4ArQr•)t t4 , ••~ :a rs DIY tk (!F"4'rtT bP pOTi ~` R$ / r, <br />~. <br />t' -LtJ:''i * r.n? :r' ;r' x.11 REQUIREMENT ~ ^"-'r 'r tdpR SY:; M : <br />DlL [ CIX ' ":1T '7! <br />!4x11![ <br /> . . . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM IAW THAT I HAVE PERSO <br />ATION SUBMIRED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MY /, TELEPHONE DATE <br /> <br />?':ICf1A T'Ci .fII II`i INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON <br />E THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, ' <br />//J~'/~ <br />~ <br />~ <br />~ <br /> <br />H TTYIPOTI TR9T1 Cc) 613 T'%1 rE: Y' ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMfI'TIN I AM AWARE THAT TH <br />G FALSE INFORMATIO ERE ARE SIGNIFICAM <br />N <br />INCWDING THE '. <br />~~ ~~% <br />~~-.' <br />// /'t~ <br />- <br />97U-E70-2712 <br />5 <br />24 <br />g9 <br /> POSSIBILITY OF FINE AND IMPR <br />3 <br />P <br />lU <br />d <br />M , <br />ISONMENT. SEE 18 U.S.C. 41001 AND 33 U.S.C. <br />li <br />/0 <br />t <br />Wd <br />b <br />000 <br />tl SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED nty up <br />en <br />18. I <br />ens <br />w un <br />er <br />ace srelufes may <br />rrc <br />e <br />, <br />a <br />4 1 <br />5 <br />mebmum lmpdsonmerrt ol6eMeen6monNC end Syeera) OFFICER OR AllTHORRED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />~. ~. i, i, (.• i ~ - -.' pr•r ~,I +.r v/~ ~ t. vc^I'~'1D 4%^T rrrr )~, f.T+rw _ ~~^ ~. ni~r t~~^. r /~ ~n'r r.. ^.~itT'V ^Tr I,^o, <br />S L i ' ~ ^.:- ' .. / . " 11 .: , . t T ' w D a ~ '; _ ~ !' : ...) N y t ~ e) r I •. !- r r ., v , 4 .T r. P 1 .... ~ .. 4 r n ~ . <br />~ ^. <br />EPA Form 33267 (0&95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) ,) n T ~ 1 / ~ ^ n „ , ~_ ~ p ~ V PAGE OF <br />