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PERMITTEE NAME/ADDRESS (Inflnde <br />Fariliry' Name/La[alion il~ditlfe~.rend <br />NAME ~.N-TS-BiarG~O~A~~D!!RA-N-~------ <br />ADDRESS~~rpF,FR~TYC __________ <br />- y:,~ 29515 ~OL-T~ CO11N-TY-ft Ol.D-E 2 Z - - - - <br />---QAX~BEElL- ~0_8U4e7-- <br />FACILITY ___________________ <br />LOCATION _________ _____ <br />ATTN: RIC1iARD A. M7LL5 NAYAGRu <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$) <br />DISCHARGE MONITORING REPORT (DMR) <br />ra-lb) (17-19) CIINOR <br />0 ~ (SUBfl YY) f~rrr~ApFroved. <br />PERMIT NUMBER olscgweae quMeew F - FINAL OMB NO. 2040-0004 <br />MONITORING PERIOD POND DISCNA~P.QrLpva~e3cpi~el~~31-~aEEK <br />YEAR MO DAY YEAR MO DAT __ <br />FROM TO ~~#'v` YO DIS;:NARGE ~- ### <br />nn a, r?a-~n nF-+n roR.+9, rm-a., NOTE: Read instructions before letina this form <br /> (? Card Only) QUANTITY OR LOADI (4 Card Only') DUALITY OR CONCENTRATION <br />PARAMETER (46-Si) (54-b1) <br />`°'" <br />(J8-45) (46-51) (54-6I) NO. FREDOENCT <br />of SAMPLE <br />(???7) EX ANALYSIS TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> (616.b (64 ER) (69~]Ol <br />'OLiDS, TOTAL SAMPLE ###AI## #Old#i'i# { 19) <br />lSSOLYED MEASUREMENT <br />7u195 L U 0 <br />L.. <br />~~ ly ~~ ,. *?pE~M a~~;c ..~li#~~I~k-, <br />" #ar :a~... "' <br />~ <br />~` ~ HEPflHT <br />~ <br />~ TBLY flAB. <br />RE'FLUENT EROS' YAL'JE <br />.. ~~NT(. <br />~U.I <br />~ , <br />~"„~~a°r. ~..:,. <br />a.~,.... _+...._•:.a.,, <br />..::'"~ <br />,,..~.....w., #### '_ ~' . <br />. ; <br />_ <br />" ... <br />n <br />IL AYU GhEASE SAMPLE ####.# ( yt<) ##00410 ###### #~~~?4+~# <br />Y IS U AL MEASUREMENT <br />4J66 1 0 U PERMIr.. >01>ON01~QI # ES=1 ?Y '`• ".-1k1010L1#0. ;:#r,~ EEItLZ ISUAL <br />E'FLUENT GROSS Y LUE REpurREM~P~tr; ~ s,I, y <br />, <br /> t! y _0 <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT' <br /> REQUIR~MEN7, '.. .~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> 'PER~17 ~ <br />' ,. <br />~ ,. <br />~~ <br />; <br />.' .~. <br />; ` <br />-" <br />~ <br /> REQuIRpME~}fi ... ':+ ~ <br />" t~-'. <br />~- <br />fit.. <br /> SAMPLE <br /> MEASUREMENT <br /> <br />I''ERMIjj'' <br />~ <br />~ .. -:. <br />~ <br />" _ <br />' <br /> <br />~ " <br /> 'REQUIREr%1ENT ( <br />.arl ~ <br />~~'*' <br />, <br /> . <br />gig.. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERKJIT" :. <br />;.'. <br />- <br />-, <br />,..}ryk~.. .. <br />~ ~ -;.t..:n . <br /> <br />e "',W''. ^4; .:; $ . ~ .. <br /> <br />. . <br /> 9EG7U11iEMENT- ' :I <br />fn <br />x <br />.. <br />. <br />. . , <br /> r <br />~eP. r .. ~ , <br />. <br />.. '. r <br />~, <br />.. . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> -PERMIT '.. '~ .«T~.is :. - ~ .5~rr :~{. -.. <br /> REQUIREMEfIr'~.`; - <br />i', <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i cERnFY UNDER PENALTY of Law THAT I HAVE PERSONALLY ExAMNEO <br />~ TELEPHONE DAT E <br /> 4ND AM FAMILIgq WITH THE INFORMATION SUDMITTEO HEREIN. qNO RFSED <br /> Q'J MT INOUIRT OF THOSE INDIVIDUALS IMMEDIATELY FE:F7N99LE FOR <br />Richard Mills ININ <br />FOR <br />M <br />AT10 <br />O <br />HEV <br />E <br />E <br />D <br />rF <br />~ <br /> D <br />r <br />T <br />RUE <br />ACCURATE <br />0MPLE <br />T <br />I <br />AM <br />AWARE T <br />HAT <br />THERE AFE <br />SIGNIFICANT PENALTIES FOq SUBMITTING FALSE INFORMATION INCLUgNG <br />( <br />' <br />S <br />Environmental Manager THE PJSSIBIUrv of FINE AND IMPRISDNMENT SEE IB <br />5C 4 J <br />T <br />( D g7D-2712 <br />) 7 Y7 9 <br /> u <br />IWI AND <br />33 U <br />S <br />C <br />6 <br />P <br />i <br />' SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />1319 I <br />enah <br />es under these stmmn mar <br />nclude lines uy ro <br />SIU.(NM1I and ur masimum imprrsrnmem nl berwern A months and ! furs./ <br />OFFICER OR AUTHORIZED AGENT AREA <br />COD <br />NUMBER <br />YEAR <br />MO <br />DAY <br />AND EXPLANATION OF ANY VIOLATIONS (Reference all a((a[hmenls here) <br />OiL r; GBEASG GHAb SAIYPLE YEQUIflSO IF RISIBLE SHEEN i3 035EHYc"D - SEE I.8.1.(D). DETECTIOY LI8IT3-SEE <br />I.F.I. SdLINITY HONITOHIYG - SEE I.A. 3. QRTRLY SAMPLING IdSTflUCTI0Y5 I.C.10; REPORT flESULiS OY HARCH, <br />33 e ~ 9- a) Pre l R/0/15 OII! 'C E R Ir- O I M. UE lf5 .1 a PAGE OF <br />Y .,,~ ,~ 00028/950214-1301 2 <br />