Laserfiche WebLink
PERMITTEE NAME/ADDRESS pnclode Faci(iry Name/Lacanon i/Dif/nmQ <br />NAME hGMIE HE_4t.UbCc:. 11CLI_L <br />ADDRESS ._ ,; ~~ j i'. N .'.. ~ " 1 F I <br />F.C. ;Ch' '(~' <br />FACILITY F p C N L A C C F 1 •! ~ !: <br />LOCATION6 U W i E C U C 1 r; r' d <br />". 1:+; a1 LCi Ar' ,:. -EFf ,; i,., TINE h':r• <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />OISCHARGE MONITORING REPORT (OMRI <br />(zeal pv- 91 <br />I( <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM - TO C ~ C - <br />(2P21) (2223) (2x25) (26.21) (28-29) (30011 <br />I <br />Form Approved. ~, <br />!' I N C F OMB No. 2040-0004 . <br />Approval expires 05-37-9R <br />(SL'FE frC) <br />F - fId~l LEITA <br />41:1E TC CfEE 9F17I L17C^ <br />• MC Cl_`CHP.FCf )__~ tom= <br />~~NOTE: Read Instructions before completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br />PARAMETER (46-53) (54-81) (3B<5 48-53) 54-87 EX OF TYPE <br />(32.37) AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS <br />(e2sT1 aNALYSIs <br />84-88) <br />B&70 <br />'"'-C~• -UAY SAMPLE =''q','LLI :SY~OL ~9Lrt .~ ( 15) <br />(2 U U E G . C) MEASUREMENT 1 ~ / FJ Ci ~JO ~-~ TZ <br />Gv i1C 1 <br />r <br />. <br /> <br /> <br />~ <br />~ <br /> <br />= <br /> <br />,. " <br /> <br />~. <br /> <br />- <br /> <br />~ <br />. <br />'.r rLpEgT GRO55 VALC . <br />~ f r ;_ ,n <br />; <br />~'~ "1 _ <br />~ i>COIF -. <br />+'u~,'i~„-. ;.- <br />~ <br />Tell Ic .. <br />tl~ . <br />_ r . <br /> SAMPLE #9>RC04 >Ot07?09 OL~>rLi ( li) / <br /> MEASUREMENT ~ 7, S ~7 ~ ~ <br />LiUUU 1 U C <br />~*- to ,~ eta <br />E- <br />•: ELUEhT GHO55 VILU ~)d <br />-. ;. <br />,~k°` ~ ±~ tt=:6 ~C ,~ a,~, <br />.. <br />LCLIUS, TOTAL SAMPLE ;~,;;-:;: r,. ><r,: ;. r,. ,~ 9y~Y'~: ) 15 <br />) <br />/ <br />`, U S F E N C E U MEASUREMENT ~ (~ I~ Z. /j J 2 <br /> <br />uU~30 1 U C <br />r-?,p~ldl - ~ <br />~ XI#~ :-. za-• <br />.. <br />, <br />~- ~~, ~~ ' <br />r 4't g <br />Fv if-" <br />G <br />"=FFLUEN2 G(iCS <br />PAIL <br />TiEQUIREI~18N7- <br />. ~-`~ ~ ~ <br />~ Y ~. ~.~ , <br />" <br />aR z r ; <br />~~ <br />tE <br />I kjra $f <br />G R V <br />:' <br />_ ,, ~. / .-- <br />CIL AND GFcASE SAMPLE 4; ;~':;'~ t~YOy::3 YCC,?•'.L rix S~:~9 1 lt) <br /> MEASUREMENT ") <br />~~ <br />U!St;l 1 ~ U C 'a'P <br />ERMIT-` _ - 4~ ~ ~_~ Ct# 1 ~,' jr~a <br />~ r... C=i'.~Iit ~r <br />2FFLUE9T GRO55 YALG RI=~UIREMCNT ~ " r ~k' '~ p `~~~~ `~,'w-. ~ <br />FLCw, I5 COIICUIT CE SAMPLE 1 G3) k~~i~Ct OL~1:r;+~ L>rYC+G9 <br />.i1EtU TRBATMF'NT FLpE,' MEASUREMENT ~,OU)~~. 1UJ3'7 c6'F ' <br />`_COSG 1 0 C "=>PEHMIT~-" .~.. ~~`:= ~ , .{.;" 'k:'~ "cr <br />~ ;.:, k~ ,~: ~CCi ""'.. C~~!]~~ its ; <br />iFFLUENT GRO55 YAIL: fiEOUIREM~NT ;34 i'>li6 ^I~it2XY <br />~l <br />'~- rCC ~'~:=~ !( :~+ <br />~;+.: <br />, ''`-x44•=.~~~ ~A4# r~~ ~~~c '~a: <br /> , , <br />, s <br />, m <br />("".CRINE, TOTAL SAMPLE ~`~';'. ....v^~ >C094;~ ~~r.c%~ ( 75 <br />, <br />~IDUAL MEASUREMENT ~ '~j ~ rL <br />': U G h C 1 D C ~ ° ~PERA+[Pf~ 't . ( - q'p ;~ 0 ~# ,__~ . t t ; ' f ~ <br />* '~ '; '~a <br />~ ~ ~ ,. Y - jl"!-k I ] E M E <br />~ft'LUENT GROSS YALC 7; <br />flEdUlAEM 1 sy::'% ;. . <br />; <br />da ~ ; , <br />`s-; <br />,. '~`'~ ~ . <br />_ <br />~ ~ rC/L .. <br /> „ . <br />. ,~, <br />. ~ _ <br />;C1.1D5, TCTAL SAMPLE r=:'=_:,~ r.x*a^+a ;"v~nta cf JJ 49c ( IS) <br />) <br />L I; S U L Y E C MEASUREMENT !; ~i /-'-~ <br />! is 19 S I U 0 <br /> <br />- ~-€'."ERMFL~r"'. _% z~ tifi! ~ <br />y <br />~ :'t ~_ <br />" <br />~ i L ~ <br />4 i4 T:~ ( <br />~ <br />'~ <br />' +' <br />Sil.: z <br />~ <br />` <br /> <br />~ a <br />~"' <br />Y <br />~'~~J <br />RCJS .~ <br />:FLUENT GROSS YALC F1E41UIREMCNT. ,. - >rC~?: r <br />~ ~, ;~;: <br />.;. ~ <br />, <br />I '~ , ~ rG I <br />NAME/TITLE PRINCIPAL IXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERE NALLY EXAMINED AND <br />IN; AND BASED ON AIY ~ TELEPHONE DATE <br /> INQUIRY OF THbSE INDNIDUALS IMMEDIATELY RESPON <br />THE INFORMATION, I BELIEVE THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, <br />/ A <br />r~ <br /> ACCURATE AND COMPLETE <br />I AM AWARE THAT TH ERE ARE SIGNIFICAM a <br />/-~ <br /> <br />) . <br />PENALTI <br />R SUBMrTTING FALS <br />INFORMATI <br />F <br />INCLUDIN <br />N <br />THE / <br />I <br /> <br />,' ~ I ~) ri~ '' ~ t"O ~. , <br />ES <br />O <br />E <br />O <br />G <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 16 U.S.C. 4 1001 AND 33 U.S.C. <br />3 <br />l <br />tl <br />I <br />Il <br />0 <br />0 <br />SIGNATURE OF PRINCIPAL E7(ECUTIVE <br />~ <br />~~ ~" ~J~ <br />) <br />1~ _ <br /> <br />TYPED OR PRINTED § 1 <br />19. (Pene <br />bps un <br />er Ness sletures may <br />nclutle <br />rres up b 51 <br />,0 <br />0 erM a <br />maximum lmpnsonmerrt or 5el.Ben6mor6/u entl5ysere.) OFFICER OR A ROBBED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here) <br />._rCHT "NCI"' (AC CtLCFIA~F. TREATrT) IF ~G CHICFLNF LSEC--SEE G/. CIL P,' ;PEASE - I.F.1.C, FC. E. <br />,+ A^.~LI!+G INSSRL`CTICa°_-I.C.6, PC. S. <br />EPAti orm 3320.7 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) ~ , C C C C S / 9 S C i 1 t - 1 `_ i f <br />LFTEIY <br />PAGE 1 OF II <br />