|
PERMITTEE NAMEIADDRESS lIM,L FsWryN~/fxarm r/Dlpb,.nq
<br />NAME
<br />ADDRESS ~~„L TIIi jcLt, ;'~;<~
<br />1J. ~.~~Vt:i ~f. c;LVt,.r J:.1 Tc tit,u
<br />FACILITY
<br />LIrL r. .{Y I-IJ:-L'J L~,.af IrrUa
<br />LOCATIONri ~; I.LI. Ll{ Ov`~,+J
<br />aTl. J~{v. t_ /r N. r.- /..ve7 ll .v•
<br />NATIONAL POLLUTMT DISCNMDE EUMINAnON SYSTEM /NPDES) Form Approved, ~ ~
<br />DISCHARGE MONITORING REPORT IOMR) OM Rio. 2 40.000
<br />11461 ll7-f9l N 1:'>... _(- :j;:;: .aT ~~ T,. ~A r
<br />ll ,., r,a. APProv~e piiee'0 -~1-98
<br />Jil .. ., _ lei`+~
<br />PERMIT NUMBER DISCHMOE NUMBER F - h l r :. L
<br />MONITORING PERIOD ''' i'•u.`
<br />YEAR MO DAV YEAR MO DAY
<br />FROM y, Li vl TD JS ~~ =1 +`+•+' Pv L, I~Cri. ,. I,t 'r ,••'
<br />!16111 l11-131 114151 116171 l18-?91 l3P311 NOTE: R~Ad In~truetloru b~for~ omplAtlnp thb form.
<br />PARAMETER !3 C.rd only! QUANTITY OR LOADING !~ Grd Only! QUANTITY OR CONCENTRATION NO, FREOUENCr SAMPLE
<br /> !46531 !5(-611 !3B-I5 l~bb31 - 546f
<br />EX OF
<br />131-37) ~ MALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 183.31 l645a1 !6&701
<br />h SAMPLE ¢~. r,<},.<p tv +S ;,y(a ;< '}{<.,<Y<,j ~; .`
<br /> MEASUREMENT
<br />'iiY JLI 1 .. C '.,: .PERMI7i: `~ {14~iadl rEr'tl ~. ~.}} Jt
<br />~+i ye } <H+• '. r .....
<br />~~~rLL,.;vT ., n' ~$ iaL'.Jt .REO.UIREMEN.T`
<br />~ ~._~ ....:.-.
<br />~ .
<br />"
<br />~
<br />-.
<br />~ ..
<br />L.LiL'~r iL(AL SAMPLE 4Y 7~'F !t ti< i<}ir ll,+P4 4a<a#,•a c
<br />%L 1:
<br />
<br />~.I ,~,_.,. _;_.
<br />MEASUREMENT
<br />~
<br />i ~J'I '~ ~~ ;,
<br />~/~j _. - _~
<br />L,~.`J a •<:' PEB.,.)T':.':' .. di+>•i?Il4{a4! : ': i•irY!~N>}: 1! $4 r (.l!~4~'i`) w
<br />~Yt:L.l ~.( V'~ ~S vaLUt HEQUif}EM.ENC; .. .. .` :.::.: _.: .~:' ;_,: "':".. ." 4r '•'+' ~
<br />3 ~ ~~, '..
<br />~L.L1t.J, a~7TLtanLL- SAMPLE ~ •r+144k•} Vir4&}'i ti<P+v4v}q j
<br /> MEASUREMENT
<br />'(:J47 i. l: ::.BERINIT:.'.'. "',$'11.i~4P$.:'.. gYr6$.rh## M' <M,t :$~+lktiv#:::: f1UNrlk~...'..
<br />'~ T
<br />` _k;:uL,~ ,L 111a.E.L: I:AL''.:'
<br />
<br />hFl
<br />clvl
<br />rtj]$$ '
<br />L
<br />ALl
<br />+~EQl11REMENT:
<br />y;/;F . . .
<br />J
<br />~
<br />i
<br />1 -
<br />.i iL {.hv ~:. I.ASI_~ . SAMPLE - a4{<.}.}p {, ~l4~0 }'- M}4µ:<5• r~. {~O}.. ,ti
<br />-hcu ~I ~x(L-T;uaY NtTH MEASUREMENT
<br />)~»~ 1 ~ G ^~::::~pMit~::•.
<br />-~ ~
<br />~ ::~ :-ti}}I~'~lr~' :: ':::b~itJl*~ fi +,~< ?ic'a~~~~.a'. i~6~xQldl+~. I.~ .' *.hi'f:d Pi' ttA:~ .
<br />
<br />
<br />.FrL.L,LN I „h bS VALUL EQUIREM
<br />::
<br />T
<br />:..:.::..::::::. '`~~
<br />
<br />,...::
<br />. ..
<br />,,.:....:.,'
<br />
<br />
<br />.~
<br />::'.c.'.:.
<br />
<br />-i~~.
<br />
<br />'.:.[~ '::'
<br />t.: i:f TL;I nL SAMPLE 4}1}}4+r 4i. {. ,,.}.Y tt i.}qr Y,a(•. ~.,
<br />„ ~ ~ t -- MEASUREMENT
<br />
<br />:JYJ i V Q
<br />~~_':';?ERIyITk`r.'~< ..
<br />~ ~!h4~:91*}~:'_'.
<br />';::.'$:?}31!~k~rki4~:.:Ot,
<br />k+.
<br />.`'!k\1'i4t,ilak:+ . , ...:
<br />~i•:7 ~.~'
<br />J~ti..~. ~
<br />~~'~~
<br />~:~(r:
<br />~~
<br />~f
<br />~`:
<br />~Ef>~:[>''~
<br />
<br />_FrLULC:T v,.U~S vALl1
<br />•REUVIR~,MENTt
<br />...
<br />4c<4
<br />:5U3 ,.t,.
<br />?~. L'i kii
<br />.•.'/L .
<br />l .
<br />.
<br />ld hTtFi .
<br />'
<br />.jL al\u JKLA~( SAMPLE yj,~ra Ya (. 4}4M},J 4•F4.1,K :• {.,}{.} S'
<br />7 'i .
<br /> MEASUREMENT
<br />3U_ i V' .i .. P A..MIT~ -. . ii ~D!;9!3d~'.':-.
<br />.: ~°~"~-.'~.~ ~4?$. '~k~ +NV '..4;!,:r'9y',}. ;<+f:s.'.4<,.$ .. ..~...
<br />
<br />.rr'.Ll+tlrT i,KOS$ VaLI:L ~REQUIREMENT:
<br />':: ., ... ... ':: ~..~ '1`..~<~.`~~ ~,
<br />~,:.: ,.,, '..' ~ -
<br />~.~.~~:~ ~.~.~ ~ }44
<br />~ '~
<br />~ ~
<br />ItiS~T~~ rt
<br />,iL
<br />•~
<br />G~k,.I'i(':-~~~
<br />~ .
<br />L,.nr lla t. L,ia uUlT UK SAMPLE. - a3 .}.}.}S av 'i <~G:J i. i. ,; {, :r ;'•.. ;.
<br />Irn., TRtGTh~E v
<br />T'LF''rT
<br />T MEASUREMENT
<br />l
<br />1
<br />JvV. V 1 U Q
<br />':.~:'.:P,ERM6~:;;'r:, y~6 I,E'8
<br />~{.?j<.:.
<br />.:.flL ~;
<br />;'':: IT P: !f
<br />... V!'~fF$M.~~
<br />ir~}rk{i#~
<br />?(r ia'y PJ :r i<
<br />4 y
<br />G ~1•
<br />'~
<br />i: (Y
<br />F:.I H-e
<br />:i
<br />hi
<br />5 VA1
<br />U'
<br />r
<br />~
<br />l
<br />til~ -BRnUl~E~ -
<br />~3G~'
<br />`- ~ .~-
<br />l~ ull - -
<br />- -~ :
<br />r .
<br />.
<br />: .
<br />,
<br />ru
<br />,
<br />C
<br />.a
<br />_
<br />v ±
<br />:~ i
<br />- ..
<br />_.'.. :
<br />.. ...
<br />
<br />:. ~
<br />{a -
<br />
<br />._.
<br />NAME/[ITLE PRINCIPAL EXECLRNE OFFICER I cERn FV uNDEb ALTY OF LAW THAT I HAJE PERSONALLY EXAMINED AND TELEPHONE DATE
<br />AM fA MILIM W1iH 7HE'INFO RMA710N SU9MITTED HEREIN; MD BASED.ON
<br />II J. /.~ ~~.y~ MY INQUIRY OF THOSE ~INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />1~~Gt'(Li'-t G'L_A' /-/tAY I/~. •t_, OSTANING THE INFORMATON, I SFLFVE THE SUBMITYED INFORMAnON IS
<br />_ _'
<br />TAVE. ACI;URATE MD COMPLETE. I AM AWME THAT THFRE ME C,~
<br />., ) :
<br />yl. y-~
<br />:
<br />a
<br />''~~
<br />SIG!!//IRLMT PENALTIES I]TI O FALSE INFORMATION
<br />INCLUDING ,
<br />~
<br />,
<br />-t
<br />- ~ _ /1/ /
<br />,
<br />~ THEPOSSISILITY DF E{NCMp IMPIIISDNMEf'IT
<br />SEE 18 U
<br />S
<br />C
<br />1 1001 MD ]S - f
<br />+ I 1
<br />j
<br />F / G ~ '-J - ~
<br />~ ~~,
<br />.
<br />.
<br />.
<br />.
<br />! Of 8
<br />JFbnrleW Jdr eM
<br />i
<br />A
<br />hd
<br />r
<br />ro S f0
<br />IX1O
<br />tl:S
<br />C sIONATURE OF PRINCIPAL EXECU7NE ~ ,
<br />I
<br />.
<br />S mrvn
<br />,rry
<br />x
<br />~
<br />ira ,y
<br />t
<br />.
<br />,
<br />TYPED OR PRINTED .'M U' n+a++mwl:mpivn.nr Plbhrwn Bn,mB,. rrd 3 y.va/ OFFlCER OR AUTHORED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS. AND tAYLANA I ION oh ANY VIVLq I Ions fJT8r8r80C1 an IRlCnm8n f9 ne/B/
<br />T]o O T{;,IAL li~T/N L1N1TS KILL. ;3t .rA1VLJ! ar,~ SET(LtAc,L~ y:.:LT,.:. LIMIT i::PL:,.;, r". .~.(..,,',', {-,::_[:' ~'viT.T-
<br />JL~ OUH.JCN ur P/C liuP ~riE vUiN~CMchT3 u14Ui n, 1.4. ~! Y, tf. u1L L JRLa;;t - Sct 1.... t.l,. :. u-., '.r"~. {. J._ L,J
<br />orm 3520- 0 T , - Preyoor: _ mom °Y be we CES FO 4 ICH MAY NOT BE USED.I PAGE OF -,
<br />I
<br />s
<br />
|