Laserfiche WebLink
PERMITTEE NAME/ADDRESS (lnelUde <br />Fatililr Name~L xaliOn i!1fj[lerenll ~ <br />NAME _ art' \_J U7lC.'.~ _ _ ~. G ~ G~NJ ~~~ <br />ADDRESSNL,W I?LK MIN?__ <br />---- ~L/---"---~ ----~_~~-- <br />------_ <br />FACILITY <br />LOCATION_ <br />ATTiI; oeT ~ - - ~~ - 7TR~ N TN"- - - <br />NATIONAL POLLUTANT DISCHAgOE ELIMINATION SYSTEM (NPDFS ) <br />DISCHARGE MONITORING REPORT (DMR) <br />c~c3t' ~ oo ':y <br />PERMIT NUMBER Oucd, u.+aeR <br />MONITORING PE tOD <br />YEAR MO DAY YEAR MO DAY <br />FROM U V TO <br />(?0-11) (?~-?.) (?4-?51 (1fi-?7) (?S-'9) UOJI) <br />S•,UfE V°T TF, S'T'lrliv F~?' n~a <br />(S I? R R S 4) Form Approved. ' ~ 2 It <br />r_ F T tq q j OMB No. 2040.0004 <br />w L N 7 P Approval expires 10.31-94 <br />NOTE: Read instructions before completing this form. <br /> (J Card Only) QUANTITY OR LOADING (q Oniv1 QUALITY OR CONCENTRATION F <br />Cv <br />E <br />E <br />PARAMETER (46-SJ) (54-6/1 Ig-4i/ (4fi-J t) (54-6/) NO. <br />EX R <br />OU <br />N <br />OF SAMPLE <br />TYPE <br />(Jl-J!) ANALY 51$ <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (JLbb (M~SI l69J0) <br />? 4A°iR Tr <br />L'SO ;TATF ~ .. - <br />~ . <br />r ( ^~) <br />. SAMPLE r. <br />~ r. .. <br />.. ~ .. <br />. <br />. .. <br />. <br />~.,~TOOgnU <br />ylA MEASUREMENT <br />nn <br />m ~''~? ~ 1 V '' <br />P <br />P <br />#~ <br />#~~~'14. ~ <br />~~ <br />~~~'~~ <br />r, v~yv~ <br />~':;- <br />TRL1 Lin <br />i4nD <br /> E <br />.MIT ~ - <br />'~cLil!sN'P 'R~SG YALU, RECUIREMENr ^. <br />YY ~N •~ C:VT - <br />r <br />^1n ~TATIS? 9698 Ar ^ "v+'a- Y~r - <br />- .. <br />- ( 2~) <br />_ SAMPLE ^r ^ ^. <br />.. .. .. <br />. <br />('I np q A ~ } ~ MEASUREMENT <br /> <br />T'{'V(!• 1 l7 <br />"~#~~' <br />=# <br />F <br />EPOR <br />" <br />~:='~# 1nkr0uM <br />fllt4~~r7r <br />?R- <br />~ <br />TRLT ,y <br />RAB - <br /> PERMIT . <br />_ <br />'I''~L~13N"' .'iROS'~ V4LU} REQUIREMENT .,; .at~ ~b~QR <br />V C°~T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~t' ~~ a"~ <br />~ <br />~ <br />~ <br /> REQUIREMENT .^;; ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ''3~f. ... <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ trs ' <br /> REQUIREMENT .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '~~ ' <br /> REQUIREMENT ;3 .;'. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERnFV UNDER RENALTV OF LAw THAr I HAVE PERSONALLY Ex AMINED TELEPHONE D A T E <br /> PNO 4M FAMiLIPR WITH THE WFORMATION SUBMITTED HEREIN AND BASED <br />^ <br />\ ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />'/ <br />^ <br />_ \ ~Y r ~ <br />`' OBTAiNwG THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE <br />I <br />F <br />NT P <br />TI <br />I <br />FA <br />F <br />RMA-ON INC <br />NG <br />D <br /> <br />/ <br />ICA <br />I <br />S <br />GM <br />ENAL <br />ES FOR SUBMITT <br />NG <br />LSE iN <br />O <br />LU <br />9 <br />D <br />~ <br />,~ <br />~ <br />~ <br />G"I '' <br />~ <br />'^ I <br />~ ~ <br />W ~ ~ <br />I THE POBSIBILITY OF FINE AND IMPRISONMENT SEE 1B USC <br />1001 AN <br />' <br />r 51 ATl1RE F PRINCIPAL EXECU IVE -~ <br />~ <br />I t <br />li v <br /> 33 us.e f 1319 (Prnalnes undo Ihese stvmea mdl <br />nclugr <br />mes up ro AREA <br />TYPE OR PRINTED 510.000 anJ pr mavmum impnsnnmem n/ heu'een D monrhs anJ 5 rears.) FFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rclrrcncr all a!larhmrms here) <br />"£? °4RT :. R, 2.~) ?'OR D°_PAILS OF TFS"' PP.OC^~?ID4, ?PORT LCS~ - STATISTIC`?. POIVT R3TI9ATF, SiR7CH TS <br />L"°';~AL TO SiA 7r TEST ORGANISMS, ANt? ATTACH 9CUTE TOXICITY TEST REPORT F04M TO ]1 `: F.. CJPTES OF ALL <br /> <br />m r <br />EPQ~ Dim 3326- (Aev. 9-BBJ Previous editions may use ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 00060/95!1623-1743 PAGE 1 OF <br />