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PERMITTEE NAME/ADDRESSR~4ANiryNe.a~/senm,fDld .rq <br />NAME d'J ~. I .. ~' : , . ", - <br />ADDRESS [f J d i ^_ h , . .- j ` , <br />FACaITV H0J1: r, d:; )U r'":,r ,.;'II?D <br />LocnnoN <br /> <br />NATIONK POLLUTMT dSCNMGF ELIMINATON 4YSTEM (NPDESI <br />DISCNARGE MONITORING REPORT (DMRI <br />1-I5I I17-J91 <br />~PERIYIIT NUMBER DISCH GE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM ~ ~+ ~ ~ TO ~ ~, ~ ~ <br />116111 l11-331 111-151 !16771 IIB-191 !36311 <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING 11 Grd On1Yl QUANTITY OR CON <br />l37 <br />37 <br />' <br />!16531 !54611 <br />l3B-151 !46531 <br />- <br />1 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE ! !54581 !5&701 <br />i,I SAMPLE <br />MEASUREMENT :: a::S~ <br />~ C3 ~:ra~7 ~~ <br />~ ~:~r,. :a{- <br />fC <br />t 1 ~~ <br />~/ <br />` <br /> ~ <br />j ~ - <br />/ ~ <br />~7 <br />J:IJU') 1 C G <br />- PERMIT <br />REQUIREMENT +X',ra.x#: GTx~G.gg g,7G <br /> <br />..~ 5. 5 :+,=~=.4' 4 q~ Q ~ <br />, ., '.r, ° P L Y i N .i 7: <br />~''~ IL`5, I'JT.AL SAMPLE ~ g:4Qa4 aaaaar,: 4?{:4:+'v . <br />~ MEASUREMENT <br />~J10 1 G p <br />. <br />. ;~;~;;.P)&Mk7:.. ,' <br />~Q1:11R~EMENT a;:^:bY;: ga4ga4 g~x Ogis?LE+fi 3S ~b NCE:/ ;Na'j <br />~ ~ <br />r m r ' <br />;uLIDS, $aTrLEn!'Lt: .. ~. `~ ~;- 4'; ;;{::}.; { ?~~) <br /> MEASUREMENT ~ //: -/` <br />JJJ4S 1 0 J PERMIT ~:'•::gr? ~ ~Y'r sraaa +R 3;: .~-<-:F •;; :;r{: <br />A L t n 7 <br />G <br />` <br />i .• <br />;j <br />¢ f <br />; . <br />d~ <br /> REQUIREMENT e <br />_ ~ ~ <br /> ~ r .v: m •~ <br />T4:/N rJTBL <br />~ SAMPLE }a7cY <br />~#"'rag G :. <br />7~`~ <br />{ 1 <br />`1j <br />~ <br /> <br />(A.a f °I MEASUREMENT / <br /> <br />1. ~ . <br /> <br />1 ,.1 1 <br /> <br />^i <br />;11'145 1 'U J PERMIT gLrOaRa aaoaa4 K -?gG a6;=Y44 j.U 1i.0 'M:: i' <br />/ .'A9 <br />~ .REQUIREMENT . <br /> •t : r <br />,- ,. , <br />~ <br />iZL ANU C. I~EJISF SAMPLE :: 'F :*:~: R°.. .. C<r :: G:cr ~-j:y,+. , { <br />j G1 I I <br /> MEASUREMENT / <br />~ <br />V / ~ <br />J 3J`rl 1 ~G U PERMIT ~. cf..xaaa ga,z a.u:: ^. tr: aR'A a>t }Y Ii:Gxt,? .? 10 ` <br />' 3 7 7 I ~+ ..~: <br />' ~ ~ <br />A <br />, REQUIREMENT <br />. <br />~ <br />r '= n r <br />F'L~~r IN ~.:1NDJT,T 1'? SAMPLE ( (J j) :A:XCarsu :ta: # '.~:rg+:{`i' <br />- . <br /> <br />.al_.yr^+EUr ~Lr~L MEASUREMENT - _ ~, <br />~~ <br /> <br />~,U 1 U D PERMIT. <br />+•^r?~r <br />a:.eGar <br />acxa«::< <br />:~gg~ ~ r ,#,~ <br />4C:"^ ,~; r <br />'`:r <br />Y <br />2~;Atl <br /> REQUIREMENT . <br />so[,rl/s ror1L SAMPLE :=7At::0 ,';;r::fr^- :;::}:,;-y r.• <br />~ 7) <br />.~ I.i$JLV: U MEASUREMENT ~ ,~ J U v f ~ <br />/! <br />lliLN$ 1 C D PERMIT :;a;s¢p1iSx 4a3ag,t -',::54 b%t7L-.-:: hGPO't .~F'9'IJ17AL " j'i?LY iRab <br />.: F f"L U c '~ v k 7 S S ! REQUIREMENT ~. Y+# t ~ ~ ~ ~ n .r -~ f I ' <br />NAME(TRLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENKTY OF lAW THAT 1 HAVE PERSONKLY EXAMINED MD <br />MILIM WITH 7NE INFORMATION SUBMITTED HEREIN <br />AND BASED ON TELEPHONE DATE <br />_ . ~ ~ ~~ , ~ /~ ~ „ .1~~ ; <br />MY INQUIRY OF THOSE INDINDUKS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS , <br />/ <br /> TRUE, ACCUMTE MD COMPLETE. 1 AM AWARE THAT THERE ME <br />SIGNIFCMT PENKTIES FOR SUBMITTING FKSE INFORMATION <br />INCLUDING ~; ~' / ~. <br />~ ] <br /> <br /> <br />' <br />~ <br />, <br />THE PoSSIBIUTY OF RNE AND IMPRISONMENT <br />SEE 18 U <br />S <br />C <br />f 1001 MD 7J <br /> <br />~ ~ 1 <br />i <br />~J <br />/ <br />~" (' T <br />)i,I <br /> <br />, r <br />/ / . ; i <br />. ~ <br />r . <br />. <br />. <br />. <br />C <br />E 1710 <br />U <br />S <br />IM <br />b <br />W <br />h <br />SIGNATURE OF PRINdPAI EXECUTNE . <br />J <br />I <br />~' <br />/ <br />OR PRINTED <br />r TYPED . <br />. <br />. <br />. <br />WA <br />u <br />r IMw moms m.Y <br />eAb /nee rp ro JI0,000 <br />ens wwrain..n inAVlm.+w+r er bn+rnemonen rWbywnl OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />CUMMtrv I, ANV cnf'L.gnnrrVn ur rrl'/T YIVIq IIVIYJ rRerelenCl ell eRICrITIOfS DB/B/ <br />.:IrL::AnLF. $JLZU$ L[a[i a1rLI°S ?sL'f IF C= LG-YZ, 2U_gR Dr..ic .:Y:.•~T 14 CLA,I":: ;,. :f- '.L+. I'" IS AFI!')~,ED <br />~Y ~./~:), T-`•~ ° .iRUN GI"ITS JILL NJP 9f: 4PVLI:iD ,°J ?fPUh7?~ Sc:A~JJii;c:i:5 -:i?F I. r'.;P., PS S pk~ I,F.i"~, Dom, <br />EPA Fam ~3 20- 1 h Pre ' s ~ itlone ay r . L - - -1 E IACFS EPA FORM T40 WHICN MAV NOT BE U8ED.1 PAGE OF <br />p~hD C nSCII; <br />(~11~Tk J~) <br />:rn-. <br />Form Approved. !, <br />T ~ OMB Noy2040-QOOg~~ <br />~PProvel e><Plree- 13 <br />1?3'1 <br />ly, ;1 <br />Y NOTE: Reed metruelione ~forf eompletinp this form. ). " <br />s4~ <br /> <br />CENTRAT <br />NO' <br />NCY <br />FRCO <br />SAMPLE f, <br />~~ <br /> lubil <br />Ex OF <br />TYPE ~ <br /> MAXIMUM UNITS 61-eJl MKrsls <br /> <br />