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PERMITTEE NAMEJADDRESS (Indudt Facility Nmne/rncarion ijDl$ermQ <br />NAME (. ~... _ , ~ , . r , - r.: , <br />ADDRESS;L.T,'+.= 1,~-. ,•~.;_,.~ ~ ~-,..,A. .,f <br />FACIUTV - <br />LOCATION <br />NATONAL POLLUTANT DISCHARGE ELMINATON SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR~ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM I ~ ")'' •~ TO ~ ~ n q l r1 <br />!20.211 122-13) (29251 /28211 l2B-291 !30311 <br />Form Approved. <br />_ OMB No. 2040-0004 <br />' t Approval expires 05-31-98 <br />Tin: n r,.1 <br />_ ... .~ ~. .. .l ll ,p .. <br />.+rr:. 1 nn:T •r ^,'T t•n T')"r n-~'•-~• <br />NOTE: Read Instructions before completing this form. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Cent Onty) QUANTITY OR CONCENTRATION NO. FREDUENC SAMPLE <br />PARAMETER (4E53) (59-61 38-95) 4E53 57-61) EX OF TYPE <br />~2~7) AVERAGE MAXIMUM UNfiS MINIMUM AVERAGE MAXIMUM UNITS <br />(B2m1 ANAL1575 <br />B4-6B ~ <br />1 69-70 <br />:: ~1.:..iC: 7'LJ TY SAMPLE R#Cr.~fi r: y•, ~,.~ ~.tK. ,,. .. ,. ! t1) <br />~ a // <br /> MEASUREMENT ~ ~ 1~~~ ~~ <br /> <br />;J il'':i 1~ 1 ~ " <br />'" PERMIT: <br />>4At Ar7~R4 <br />,Ci~a41'r. <br />t~: r, <br />~ 7017lAII{AI Ai~ <br />$?11~ <br />R"#,,, 'al{ <br />MN!`/ <br />~..!¢ <br />p}f1S~~~1 vee <br />~'~~i;lt' <br /> <br />1 cYL Ur. 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SAMPLE ~rr..t .'r ':zt.- <br />3n rA~ntw 1 <br />~ ( 01 ,`J1 <br />:: IJ ~ P E'i D E D MEASUREMENT ~} ~1 u N n 1~-~ti <br />10i3U D If ~ PERMIT QAeGA:xp Olr7k7~agr r-;`.r 4R4#R4e 1-T4PtlR7 RI'!'~1!'~'- ~ , <br />'::Y CO'",gEN7'S '•, I.1r REQUIREMENT K:'rrvt ~ 3~DR RYi 11k~'F. <br />~ <br />. <br />1#R °''/1 }L ~ . <br />4~ <br /> <br />.i') 1DS• T1Jr~r• <br />SAMPLE <br />;:'r +FC G~: <br />Ct.x?r- <br />r:t..... ,. ,. 11 <br />' <br />''7 <br />~ <br />r •,1 (~ <br />~ j <br />'1 <br />} <br /> <br />i J' p E N D P ~ <br />MEASUREMENT l ( 1 ~ ~ f1t" <br />~ <br />IJU53U L L1 7 .'PERMIT Ori404a aa~aoa K"th a>R#eec jg 7 '! H}!!~J«~ , <br />IF°iII ['NT r^7c vCT •rs REQUIREMENT rr:~t: (: -. `1$11 (t' 0-Y: t5R-t,T M• ,.~/T. MtY/f'RN ~: <br />~L):.IDS• }~':r°~°p'T•' SAMPLE r: +,r.~•;^ nt«~•r:: ,.,.t,...t / 'i1 <br /> MEASUREMENT ~~ ~ ~~` ~F'~ ~t~' <br />11l1S-tS 7 !) f} PERMIT FAILmAri 111-4R#Ar;70 ar,rs 4d'd<~f#'" ~r~, <br />~~~ +LS-~ `?:.~' ~„'• ': ~ K~$$/. -.. <br />t: CO M'" i. ti* S rr' I C'4 REQUIREMENT ~ Kr'I : S '~' ;~. A <br />' - u <br /> <br />;: •lLi S, jaT TLc q.I I,F <br />SAMPLE <br />n..:rtr•X <br />~^e ~r`k:t <br />n.^-n~.r r. <br />~ 7t;~ ~ <br />~ I <br /> <br />MEASUREMENT ~O• I r / <br />l <br />i.JSa i 1 U U PERMIT ?tX Sf Ohtx - i3~aw 4r ArMtlP ~ "?S` 4 .,. ., ~' `~. ~.,qr`,-:.. ,~.~. ,. z ~.. r ~'. ~ N~f~`f 11" <br />~ <br />"r:•L 7ENT 6H:75,; Y~Lnc REQUIREMENT ~ - ra~T .. ,$i?~Ik ~~X17~. TS II.~~ KT(_- 'Ir/r <br />~ ~ r; k <br />'~ <br />: <br />:].L E C;Vf: llSr SAMPLE '1`•RGC to t.''•p ...tom,, ., ,: ..,t ^: f~r•~ ~ ( <br />1„1 u ~)~ <br />~ <br /> MEASUREMENT <br />vOS`_~o 1 fJ U <br />PERMIT ?4797LY41 ~iE 9Lfi ~- ':rvp r Tf++l~fdtt47r - dtQlOtYII#C. A - - .-.,,~~, <br />- - t+~, <br />~_ ~~ R ~R.~.~:,- <br />:p-f,ll;.* qn~-~ vo-L'1~ REQUIREMENT ~ '+`:r~ S@T~'!' 7!R?t '"f:/?, ~. N1` ~~~=`~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I OERT FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND TELEPHQNE <br />RE <br />N <br />AND BAS <br />D <br />N MY DATE <br /> I <br />; <br />AM FAMILIAR WITH THE INFORMATION SUBMDTED HE <br />E <br />O <br />INQUIRY OF THOSE INDNIDUAL4 IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ <br />Richard f.lilis THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br />. ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICAM <br />~ ~ <br />97(1-870-2712 <br />(~ <br />"F ///~~~ <br />~j!~ <br />^,VirOnl^.HntBi F.ganDger <br />` PENALTES FOR SUBMITPNG FALSE INFORMATION, INCLUDING THE I ,1 <br />l 1 , <br />_. POSSIBILftt OF FlNE AND IMPRISONMENT. BEE 1B U.S.C. 4 7001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED § 1318. (Ponett/av untler Mace sNMW mBy /ncluea fines up b 570,000 Me or <br />mex/mum lmpnsannren(of belweenempn6a ene5ymrs.) OFFICER OR AUTHORD:ED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY vwLn Nuns INererance arl erercnmenrs oars) <br />- TS.. r S°+o L"A i 9" T.} t~9 A. ~,~/r n ~_ n- -Ya nq._(. err r.C....T Tr <br />.. i., •:Rti1'I'F 6I 7". rnv T.. ^7L? (. C Ti "D G1• r t v••~ <br />ri11 "1 R.~• 5?P 1~4~ 1. Fl^ )'f. ^(t7 ,]f}'f~C:l 1r 7~77F PC~n i'1 l'Y^ti^^.• nTf C 'rnt~i. rC^ Cr?~.. ,l ~I ^•p n/I n 1• <br />EPA Form 332o-1 (0&95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) n ,~ } o ~ ~ o ~ ~ 7j T 7_ } S ~ ri PAGE T OF <br />r <br /> <br />5 <br /> <br />