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PERMITTEE NAME/ADDRESS (Include Facilirv Nume/Lntation ifDifferentl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES)
<br />NAME DISCHARGE MONITORING REPORT (OMR;
<br />f"11 n~ia 1'rn^i rn Mnl uV + '.r a; nv. Oi
<br />Form Approved.
<br />OMB No. 2040-0004
<br />DDRESSCU LOi7Y0 F1INE -- -- --- - r4tadr.lti A~ nna."~`~~ ..PP~~.o~",P~~~"•.•-,•~-~•.
<br />(SUf3R NW)
<br />5131 S TA TC H I G H W A Y 1 3 PERMIT NUMBER DISGNARG' NUMBER F- P! N A L 190 ?
<br />~ACILITY CEEYCk ~O H15 MONITORINGrP.ERIOD
<br />~ LOA DOllT SECI POND TO QILSON C~
<br />YEAR MO"~~"' DAY Ll'EF,R~ MO DAY
<br />OCATION _
<br />.
<br />FROM ;)U bV,','O
<br />L TO~OQ 1Z 31 °`n•'•- KO DISCHARGE ~~~ .'tt:
<br />.
<br />A T T N : J . U . .9 A R"O t. , G I ~ ` i n . L. t; A'+ A G rzo zr7 (zz-z37;~z~z'(zs-8]) . (2829) (3o~3n
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<br />YY NOTE: Read Instructions before completing this form.
<br /> (3 Cero'Onry) QUANTITY OR LOADING G
<br />id Ony) OIIANTITV OR CONCENTRATION
<br />Ca
<br />~ NO. FkEOUENC SAMPLE
<br />PARAMETER (as-53) (54-st).,,~>, ,.~ (38-45) (as-53) l54-sr EX of TYPE
<br />(32-37J AVERAGE MAXIMUM ~ UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(sz~3) ANALYSIS
<br />Ira-6s)
<br />69-70
<br />>H SAMPLE •. r: r-:: ~: ...: r::: :: -: gIOO'-,IC+71 ( I?)
<br /> MEASUREMENT
<br />)U4UU 1 D 0 PERMIT #ktrxV+p# ,•}#Ltn74V V '^r~'- '" ~ ~, ;'• L°j3ML4 (NSIT'
<br />FFLUPNT GROSS YALUE !REOUIREMENT ,c,•:~ .,'t'.Ly {, ~'~~,'~{` ~ gU
<br />1011 U5, TOTAL SAMPLE •-. - '~: T'+"`^:'' ••,, IRYiys+.t ( 19)
<br />iIfSPENDF:D MEASUREMENT
<br />
<br />)U')3U 1 U, U
<br />-~ .PERMIT
<br />q"Xr4$'t`•+}
<br />at-S##R# L' y
<br />:`.A d
<br />3'-.
<br />~ f .:.
<br />1
<br />~~.~~j1 ~
<br />i:~A~7-.
<br />?FFLUENT GROSS YSLUF ,FiEOUIFiEMENT ~ - r, =~C ,~;;~•
<br />,~ t' ;~ ; ~,~~;~ HG/L ~ ' FFOl111R
<br />iOLZDS, SE!'[LBABLE SAMPLE rr'^+:::~:-: ;-,'r.er #4041pa ( ZG)
<br />' MEASUREMENT _
<br />)U74S 7 U O. "PERMIT #%<1i+Ri+tr ax0441RG q ~; z ~+`:u°,+b~~' b`' P I 1t~
<br />:
<br />~~
<br />dPPLUENT GNOS3. rSLU E _REOUIREMENT _ ;;~ ~ ~ - .
<br />' +7;
<br />[!iCN, TOTAL SAMPLE Y~x1"::'°'° ~#007k • ( 19)'
<br />(AS PL]. MEASUREMENT
<br />
<br />)1041 1 U 0
<br />;:;PERMIT
<br />II#A%t4tiX
<br />~r 4T4CT#XT •E
<br />r,'.;
<br />.~
<br />`'=~ r ~
<br />~ y
<br />1~~-a"Y$~:
<br />;FFLUENT GROSS YALU° MREO[IIREMENT r:.•t .=.• "~~';~,_ " ~G/L ~„='++s-'
<br />)IL ANU GREASE SAMPLE gr.:;: {;,,Y':< . . ''Y wrr:5;:# #~d040
<br />= ( I9~ .
<br /> MEASUREMENT ~ f'
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<br />)1SF11 1 U U ~+ :,"PERMIT gr4400#. #~'trXri4~ x r. ;:fi 00c0##4'
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<br />iF'FLIJENT GRO55 VALUF 'REQUIREMENT .:7+`^. .f.M
<br />~- ,., ~ ~'}. ";,=g- a (9(i/L ~ rr
<br />zLON, IN CONDUIT OR SAMPLE ( L'3) ~°^'~~'#`'~ C+4P#08' ~ "i~gl-~>n%
<br />PHHU TREAT!'1ENT PLANT MEASUREMENT
<br />~UUSO 1 U U ~ -;..PERMIT ~- ~ R~P~'}'- ' -'RY,'P~',A~~ '+iFIII~ ` ~ ~ 5104 v ~' ~~,~'~
<br />fFF'LUY
<br />NT GROSS YALUF rREOUIREMENT _
<br />';~
<br />~{1*' 4~~`' ~S~
<br />pAtt~ FF 71G^ ~ r'
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<br />~ °
<br />-`` 0r0Q ~ ~ a"
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<br />4
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<br />i0LID5, TOTAL SAMPLE ~""% ""` r"~~r"~•`~'' riat'>*+t#
<br />~; )
<br />~ 19
<br />)I:iSOLYED MEASUREMENT
<br />10195 1 U 0 PERMIT -31'40itg4~"- , '4Cp9Pfi+Ct iR ':aa:~ WI7R~Rk~ilk° ': R:1~~'~~~~ '? _.. ~ 3
<br />~ k'~~~'+)
<br />iFFLUF:CT GRO55 YALUf REOUIREMENT - `4r:^: -~~QDA ~~~ --~{>•~~r~ ~6/L ,, ?.. ;,at>.'(
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY
<br />' INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ T
<br /> THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, U III
<br />SSSTTT
<br />~~
<br />111
<br />
<br />r
<br />/I w1 , 1 A ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S.C. 4 1 Wt AND 33 U.S.C. "
<br />r
<br />YYY
<br />SIGNATURE OF PRINCIPAL EXECUTIVE Q~n fi~y-1Gnl~
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<br />
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<br />TYPED OR PRINTED § 1319 (Penetttes under these stermes meY lnclutle hoes up to E10,000 u+d or
<br />maximum impnsonmerrt of belween5mpnths entl5years.) OFFICEfl OR AUTHORIZED AGENT AR A
<br />pE .,NUMBER
<br />YEAR
<br />MO
<br />DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments het)
<br />Sc.TTLEA&LF. SOLIDS LZ'IZT AC•P::IES UM1LY IF' C=lUTR,2~RR PHf?CI4 ^cVFNT I` CLAT!1FD. IP CI,~~' APPROVED ~Y Y~CG,
<br />f55 E IRON LI9ZT5 ViLL NO1' dti APPLIED TD 9FPORT'FD ^sERSORF.FIP,9T5 - SE8 I.A.2, PG. 5 FOF. FUND'3N Qf PROOF
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<br />'OB-95) Previous.etlitions }nay not be useG - '(FIEPLACE$.EP,.A F.OFIIYI~T=40 WHIbH'MAY NO.T. BE USED:): -' " ~ ~~ " ~ ' ' ° ~"~ PAGE OF
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