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PERMffTEE NAME/ADDRESS (Ixtude Faciliry Nmne/LOCarion i/DiBe.rnr) <br />NAME BJYit: °~~~".OTT ~~F::~ (i(~."';;l <br />ADDRESS BOYIi: Nom. ' ~` L`. ~~. <br />P. o. Hox ~: ' j <br />E'AOYlA ~C ;)1423 <br />FACILITY <br />LOCATIONSCYL`. OO $1429 <br />:\I'1'e;: 4iLLIA~, 5. - 3AF JN.. '7IyE R:;q <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMRI <br />r OMB No. 2040-0004 <br /> p-tel (t <br />- e) . I y 7 q A <br />31-98 <br />i <br />es 06 <br />l <br /> pprova <br />r <br />. <br />exp <br /> ~ (°n9R ~C) <br /> PERMIT NUMBER DISCHARGE NUMBER a _ FT NAL D?L?A <br /> MONITORING PERIOD DSCRG 0° SR 20 DFFR TR4IL !~"~~tT <br /> YEAR MO DAY YEAR MO DAY <br />FROM J 07 71 TO 00 0~ '~ "-" !7 '' D: `C HAFG°. ~+' <br />~ <br />pazl) pz-z3) pa-zs) pQZr) peas) (3oat1 NOTE: plating this form. <br />Read Instructions be(o <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4B-53 (5481) (3B-45) (46-53 54-B7) EX OF TYPE <br />(~~~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />fszm) axaLysrs <br />(ea-sa) <br />69-70 <br />JIL ANU CHEAS°. SAMPLE •r}vPO. ( 4U) ~##,~~•.,•-. +i`--'fi'.#" -,~,~ t. <br />Y I:i U A L MEASUREMENT <br />o U U 6 6 1 U 0 <br />..:~ <br />~ ^ s .~1!#NNIlV I!# " ~ ~ E S=1 R f~ !~, : - #1)titFA~# 'w~ #3~~+iY Ik O~; <br />;.. . <br />r.FPLUS'N? LROSS YALU ~ ~ NT, ~'.,;I `~'""~~~~ ~~ ~~ ~ M0=0 i ~`> ~ ,-'" tbr}'k <br />• SAMPLE <br />. MEASUREMENT <br /> PERMIT ,,;' <br />~ ~ ~' ,~ `~'.~ <br />- ;{ 4, ea~,'~= <br />~ <br />' <br />' 'aur.L :..,'~~y; r,;' a ~` k• <br /> REQUIREMENT ` - ~^ • • <br />3 + <br />~ <br />` . <br />^ <br />~~ trfi- <br /> _ ~ <br />, <br />. <br /> SAMPLE ' ,' ~'~y- C'~I ~ ~ <br />' MEASUREMENT /~ >(~`~" <br /> PERMIT /y .:° <br />~ -~ ~ ~ F <br /> <br />REQUIREMENT <br />tl '~'~ <br />- - <br />""" ~; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # Y-„ ~' - "rl <br /> REQUIREMENT ~' - '"~'~ - "~'-'= <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT . :. +~ n.' ~ ~ .. , ~~ - tx: <br />~ i` ~ ~ :" <br />~ ~~~ - - <br />~ ~ , ~ <br />) `. <br />:- `+e <br /> REQUIREMENT, t~ ;G <br />~" u v <br />w ~ ~' ~ <br />' ,yt;±d <br />„~ * . <br /> SAMPLE <br />MEASUREMENT <br /> PERMI>h: - - - ~ r <br />~ <br />- - ' <br /> REQUIR~MFNT - ~ '~ <br />-- <br /> SAMPLE <br /> MEASUREMENT <br /> PEE3MIT -- <br />- - "' , - ~ bir <br /> REQUIE~EMENT -'~ ~ , x, <br />NAME/TITLE PRINCIPAL IXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> <br />j THE INFORMATION, I BELIEV <br />ACCURATE AND COMPLETE E THE SUBMITTED INFORMATION IS TRUE, <br />IPM AWARE THAT THERE ARE SIGNIFICANT <br />i <br />~ <br />~~~ ~ <br />~ <br />a7 <br /> <br /> <br />~ . <br />T <br />FAL <br />E <br />NF <br />RMATI <br />N <br />IN <br />LUDING THE . <br />~ <br />~ :,..J ~ Z - <br />r <br />. ; .~ j t ~ <br />~ ; ,-/J / ~Ji( PENALTIES FOR SUBMIT <br />N <br />POSSIBILITY OF FINE AND IMPR S <br />I <br />, <br />G <br />O <br />O <br />C <br />ISONMENT. SEE 1B U.S.C. 41001 AND 33 U.S.C' SIGNATURE OF PRINCIPAL EXECUTIVE ( C~ ~ J•~ S ~ <br /> <br />TYPED OR PRINTED 4 13+9. (Perettlw antler Breve statures may inclutle Nnes up ro 510.000 antl ar <br />maximum rmplswmerrt or beMSenBmonths arMSyaers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />--°.:TLEABLE SOLIDS LIMIT APPLIF,S ONLY IP C10YR,2'LNR 2P.?CIP FVF"7T Z; CLAIC"D. IF !'LAIN AFPRCVF.O `IY ~.;^D, <br />•i iti E IRON LIhIT5 YI11 dOT E APPLI:'D TO Ri°POR?ED '!EASURF.ME!4TS-SP,v I.f.2, P~ 5 Fqq 9!IRDFq CP p900F <br />EPA Form 20.1 (08A5 Previous a Itions may not be used ~ ~ `~ ( EP CES~E A F T I MdY NO BE .) -' • - PAGE OF <br />~ ~~:71U/q~031 2-122? <br />