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•lRMITT[E NAM lIADD R!!a ((nrlnd[ <br />FLtilfry Name/EOCLJbn if diJJerrnr/ <br />wDOR[n <br />- -IFG~F.-:-Fl- =!S$:!-~_`-~!~C~!-F-E-IBC=~1-~~ - - - <br />-- .ice ~- .. D. r•D DT. .. T" <br />~~- T~L~Z°.i~TrG-{T-JrTr~~T-T-- <br />---z^--l~.-F~'-? _^.-ILA-_ -----~~' $1~3~- <br />PweruTv <br />-------------------- <br />LOCATION ______ <br />~ c co <br />N ATIONwL rO LIUT/1NT DIICN ApO[ ELIMIN nTION IVITLM (NPDESI <br />DISCHARGE MONITORING REPORT lOMRI <br />1 /6 /~ <br />r ~. /,.) <br />PERMIT NUMR[R ~ DlscH wwcE nUMLu <br />MONITORING~PERIOD <br />YEAR MO OAY YEAR MO OAY <br />FROM 9U 07 G1 98 09 30 <br />l 01l/ 11223/ 114~2J/ 11617/ l18~291 /30411 <br />M I N O A Form Approved. <br />(SUER MC~MB(No~1r0i40-0004. <br />F T'[ P I N A LApproval ezplres 6-30-91. <br />FOET-wINiNG RUNOFF :EDL E'Ohu <br />z<°~-•' Nli L'ISCN.AAGF ~I #L"' <br />NOTE: Read instruetlon[ before plating this form. <br /> <br />PARAMETER (3 Card Only) DUANTITY OR L ING <br />46J3 (4 Card Onlyl OU ALITY OR CONCENTRATION <br />NO Fq EOUCNCV <br />BAM PLE <br /> ( <br />) (J1fi/) (3baJ) (16J3) (J161) . <br />E% DF TYPE <br />(37-37) ANU rsls <br /> AVERAGE MA%IMUM ry1T6 MINIMUM AVERAGE MA%IMUM UNITS 62fi3) (61481 (69-IU) <br />PH 6AMPLE <br />MEABUREM ENT #N###O #####li +sx~##ql# <br />( IZ) <br /> <br />GOu00 1 G G a •PERM(T':~°: <br />~RH4 <br />1REM ENT• -,r^ °~" <br />~'~ <br />~„ <br />°s~ <br />e <br />IG:E C: °..,~. <br />A(Ly6p~~ <br />, .as'° ~ <br />~~'~I <br />R'~~~I.~ <br />%a <br />a ~ <br />~°w <br />° <br />$ <br />{ <br />~ <br />~ <br />a <br />C GC i I 4 a&° ~ <br />+ <br />° <br />'°~ <br />x <br />~Sx° ~...)«e' <br /> <br />bra Ya . , <br />~~ <br />i' <br />•~.`S+^ ~ <br />e <br />a <br />' <br />s <br /> <br />II ~i. <br /> <br /> <br />°( 'e` <br />..a ~~, <br />i <br />SOLIDS, SETTLEABLd SAMPLE <br />MEABUR ~: {E###O ##TA#~# - --- ( L5) - <br /> EMENT <br />GO545 1 O O ~RHOUE$MIT' f <br />EN HNT <br />, <br />%. ?r~1I) <br />" r <br />~ ~R <br />. <br />A~~ .,xe,~7gr~~E~,y <br />~ <br />c FF8,,,AAA~@ .Lr Haxs,, <br />` <br />e <br />' <br />~ <br />~ °a <br />" <br />' <br />~~ Y.~' ~~ <br />~ <br />C T fl e <br />~.E:^ " <br />P <br />;Ma° .I~M_ ..x.dE.;6C <br />k/,+P J: ,e„ <br />-e:~«> <br />, <br />eZx?7 a. lllla <br />i~eb re ~Te <br />~d' <br /> _ <br />. <br />GIL AND VAEASc MEASUREMENT ~~~~#~ ~~'~~#O >r ~>/### #{:1J1##Y I(uy `~) <br />FAEON E%TA-GRAY tlEi <br />G0556 <br />~ I O O <br />PER~I ENT- <br />REOUIR N~ y,-A:,- <br />tt n#TF~q e, <br />~i° <br />i~ak°~?~;T"3P..)cY <br />t' <br />YSI#KI <br />~f <br />3•~e"a <br />a'e,S°Y'~°.°°abp °rr`E,°.~~a <br />t°'gl: <br />. dk~[e x ~~ <br />I6 <br /> <br /> <br />^p <br />3 <br />, <br />u y <br />FLOP, IN CONDUI? OR MEASUREMENT l C-3) ~.TQaaae oaa~av# a~#rrooa y <br />TNRU TREATNENT PLAN <br />50050 1 0 0 ~ ° :~;-~ ^ <br />"R[4UIRE/A YN~T. rytA ~_[ <br />~VAI <br />i° <br />, H41,~'r <br />A,3 w , ° <br />&'e SCI#~d^ <br />~~ <br />~~ ~".• ~>j~al <br />.. <br />^~ <br />V e,~~yS.~,~~' <br />° <br />#., C. <br />, ~~,>~_. <br />e,at ° .>~"^1'~ <br />~" •~*gsrC,',~~~;.~ <br />3 <br />Jl <br /> <br />L' C f " ^ <br /> <br />. <br />M r. „ <br />s' <br />~ a°°'. <br />~ y <br />, <br />:Z<.°~i++=•°i *°a <br />" a~X ® <br />^:b`a'. ° a <br />ne+° ~~ , <br />Y".~ <br />.. %.f4".,°a <br />SOLIDS[ TOTAL SAMPLE <br />MEASUREMENT ##O+ppd X00#0~# ;t=t#K:C:,< ( lg) ..- <br />DISSOLVED <br />70295 1 0 0 ~~~:: - -~.., <br />~PERMIt," <br />s.RHQUIREN'ENaT. , . <br /> <br /> <br />° <br />:*~Xf #d <br />~ <br /> <br />~ ~A~'>°a <br /> <br />~M~ <br /> <br />#N"^v e.« . ° ° . <br />1 <br />.:!`~~aC R.~~: . e _ <br /> <br /> <br />s;, <br />. <br />~ <br /> <br /> <br />, <br />+'m< oa^,~pq! <br />f~ <br /> <br />'~~ <br /> <br />~ ° <br />°' <br />••~~ <br /> <br />. <br /> <br />a <br />+s~°m'+°r~pla°I <br />~ <br /> <br />c r c <br />..'t; <br />~~ , <br />r% <br />" ~~ <br />~ <br />-~~'~h ~~;-~~' <br />. <br />r <br />~ <br />~~ <br />$ , <br />a Y <br />T r <br />d <br />aK <br />>? <br />~ <br />~ <br />'~ ~ <br />~ <br />' <br />~ <br />c I ~a: ~ <br />a <br />G ~a I < <br />s._ <br />< <br />5 ~ <br />~s< <br />l <br />ffin <br />~ <br />F <br />8"p $• <br />. T:4 <br />. <br />OIL AND GREASE 6AMPLE o#e#ee ( au) ;E#~K~,xr. ~~,v>;a'##>,T w #o#a## ~~~ <br />V I3U A L MEABUREM ENT <br /> <br />b+1066 1 O O ems.. ..'.T <br />REQUIREMENT Y>, <br /><q*Y~ <br />n r,¢ g °:, <br />~a3 <br />#~ <br /># <br />*' <br />~ <br />ES=1 ""Ab< gx <br />,~c <br />Y"J'F~9' <br />'~'''a Y'g,"# W~Ff"Ya <br />8 <br />~ <br />* <br />° <br />'"RT+R .tiA.s ~ <br />, <br />~° <br />a <br />~ <br />O#d :w a. <br />~ <br />°~y', <br />. ~R <br />~PoD f.., a&>T~ <br />1a..°. <br />j <br />c 1 L• r e e , i <br />a <br />: <br />a <br />i°, _ 1 s <br />, <br />° ti " <br />8 r <br />tl <br />a ? <br />, <br />f <br />°~ ~. n... . <br />v <br />:N~a~, iRx ~ <br />'`Ta <br />°.$ <br />_ SAMPLE ---- -- ,• ' <br /> MEASUREMENT <br /> x ., pbj.RNl7>I .-<' <br /> <br />`R EOUIR M <br />H6NT, ..e ,°, '>'~°", <br /> <br />^sX <br />~ T. ;3°:~x e~~~ $" <br /> <br />3 -t <br />~~; r° e <br /> <br />~ % ..; n <br /> <br />s <br />` ~_..A'. .. <br />°"d,s <br />T°~"eF°~a"c a.?y~$G.a, ;qqa <br />a p <br /> <br />°• <br />~ 1 <br /> <br />![g~~p <br />~ <br />'~- q ~Po r. <br /> <br />~e a'A <br />` <br />l <br />' <br /> ~< ~. r <br />~ s "e <br />'gTnEa Qa°'°a`!~~. E4 <br />a <br />K ' <br />]Em <br />a <br />s <br />NAME/TITLE PRINCIPAL E%[C UTIVE OFFICER r CEwTIFr unoEfl PENwLTr OF LAw rnwT I HAVE PERSONwuY E%AMmCD <br />AND AM FAMILIl1fl WITH THE INFORMATION S <br />BMITT TELEPHONE D A T E <br /> U <br />ED HEPEIN. I1ND BASCO <br />ON MV INQUIRY Oi THOSE INpVIDUALS IMMEgATELY RESPONSIBLE FOR <br />/ / <br /> <br />,.. / <br />n <br />E <br />\ <br />J <br />~ <br />Y OBTAINING THE MFCRMATION. I BCLICVE THC SUBMIITED MFORMATON <br />IS TRUE ACCVRATE I1ND COMPLETE I AM AWARE THAT MCRE ARE SIL <br />NIPICANT PENILTIC$ FOfl SUBMITTING FALSE INFORMATION INCLUDING ~ <br />p/VJ/J~~_-~J <br /> <br />/ <br />1 <br /> <br />/ <br />~ <br />~~~ <br />~ <br />J _ <br />T <br />` <br />V 1 <br />~~ <br />` <br />THE v0551BILITV OF FINE An0 IMPRISOnMEni SEE IB VSC / 1001 AND <br />]3 u5C 41]19 IA <br />l <br />N <br />A <br />I <br />l <br />d <br />IGNATURE OF PRINCIPAL E%ECUTIVE . <br />y <br />• ~ ]Q 4~J <br />Z4-~~ lJO~ Q <br />y <br />/ B <br />/~ <br />l~ <br /> <br />TYPED OR PRINTED nr. ul <br />na <br />rr I <br />rw <br />ululr. nu nr <br />u <br />r /Inn uY In JII/M1n <br />wd.,. munmu.n lmP.nu,mvllr.,l n+lu..n 6mlmtA. and.i.wrv <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />MCIVI ANU CIIYLANATION OF ANY VIOLATIONS (nrJeo-nt'r nll ulluoRmtnll nrrf) <br />ScTTLEABLE SOLIDS LI!!IT MILL BE WAIVED FOR ~1C-iH, ~4-Hit FkdCIP EVENT-5EE I. A. t, Pi: IV, FOR REQUIR:I'I~cN1'S. <br />((RTkLY SAHPLING INSTRUCTIONS-I.C.9, PG I%. 3C DAY AVG ZS HIGHii~T NONTNLY AVG LURING F?'NIOD REPOAT~L. <br />EPA FOrm 3320.1 (Rw. Y-88) Y/[VIOYE ICIII%O/1$/IldY be l/SB.~. (NEFLAC [L [FA FO NM T-.0 WNICN MAY NOT [[ US[D.) FADE OF <br />0008ti/940412-1838 <br />