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PERMITTEE NAME/ADDRESS Qnclude Facifiry Nandlaranon jDigerenq <br />FACILfTY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) FORM ApprOVSd. <br />DISCHARGE MONITORING REPORT (DMR~ OMB NO. 2040-0004 <br />rz~lel nr- sl " * ?"" Approval expires OS-31-98 <br />PERMIT NUMBER DISCHARGE NUMBER c _ •~ 7r n""'1"' <br />MONITORING PERIOD ^~^„"^ rm Tf•,t +~:: l- ^.) / ^,7'T <br />YEAR MO DAY YEAR MO DAY <br />FROM ,, ~ _ TO ' 1' ,. ~ ~ ^ .. ~ .) , ... ~..., , ~ ,- ^ f --) r: /.., <br />(zaz11 Izz-zsi (zazsi (zuzrl tze-zsi faoaf/ ` A NOTE: Read Instructions before completing this form. <br /> (9 Card Onry) QUANTITY OR LOADING (4 CeN Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53 5481 (3B<5 96-53) (54-61 p( OF TYPE <br />(3z-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />16z-rat awv.~ls <br />(6x68 <br />6&70 <br />~~"-F"r'CT :i T'^..^ n:` SAMPLE ~;=r:o t.^ FF ~t!e'f ..mow.!..:,. ."fr'_ ( ^T~ I <br /> <br />CIi:/ CFF'T'T:1;^i'.4Ts. <br />MEASUREMENT <br />~ IOC <br />/~Z n <br />CUMO <br />~'C~Ja 3 D ~ . PERMIT'c~ '~-'C+OtC6,rp `,x¢44 e~':: ~tM'.. 9r9e*iR~kdlr' #i;±kiage'!r- <br />p ~^- , <br />- <br />3A4LP <br />J.'.f V7F~V ~hT4 qP <br />Ll': REQUIREM <br />NT i ~.R <br />4-., O AJR "~~ <br />ftT~' <br />~ '^~ (' c'wgY ~ . '~ <br /> , - , ~ s . , <br />.;, ~-v :r•^ 'i flifr'F' y7RY <br />' SAMPLE nY:T OrGS .TffG:Y r; <br />d .n :t J!.-~rT ^tr <br />'.: r,. fiY- ( ?]) /~ <br />~ <br />I/ (~ <br />i.' PS"FPti~°~ <br />- MEASUREMENT U <br />~ I J 9 Z `OM.7 <br />'C't,C F. [} <br />" `a <br />PERMIT `~ „ plP .#iF <br />#= if ~ ~; r..-R '" '.~'`f5 a"2' ~c4~~~ 'W: •n- <br /> <br />;i c CD:!MaAC; 1-L'lY „ <br />REQUIREMENT. . <br />:; <br />. <br />~'~{'" <br />~ <br />-'T':p <br />;r~~ <br />~ ?.' <br />;,'y_-..- ;• <br />;.~ <br />C^vm <br />„iC~':..' <br />. , ,,;, . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '' .~ <br /> <br /> <br />~ "~ ~ .,,;" "" •:.. . <br />.- <br />r, <br /> REQUIREMENT ",'_~,`; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~,'+.: t;'.. .. ?~.," <br /> REQUIREMENT - ~+'4~ "" - <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIT ~ <br /> <br />' <br />1, <br />~~ ~ ~ ~ <br /> <br />` ~'#' <br /> <br />' <br />#` <br />~ '~':= <br /> REQUIREMENT - -~ c ,~ _' t ~~, *~'~ ,.~ +f <br />~ 5": ~ € <br /> SAMPLE <br /> MEASUREMENT <br /> - = * <br />•--.= s„ ~, <br /> PERMIT - -- . } <br /> REQUIREMENT - - a :gyp <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />~ - - - - - f ~ -t .~rw <br />- 6 ~. <br />REQUIREMENT <br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EXAMINED AND <br />TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORM ATION SUBMNTED HER ~ <br />EIN; AND BASED ON MY <br />INQUIRY OF THOSE INDNIDUAL <br />1•~ ~')III9 THE INFORMATION, 1 BELIEV <br />F':IC ~'Ic S IMMEDIATELY RESPON <br />E THE SUBMITTED IN SIaLE FOR OBTAINING , <br />FORMATION IS TRUE, _ /,~ ~ //}~-//j <br />: <br />ACCURATE AND COMPLETE. <br />er PENALTIES FOR SUBMffnN <br />a <br />`'i <br />E <br />) <br />t I AM AWME THAT TH <br />G FALSE INFORMATI ERE ARE SIGNIFICANT If~ i, ~~~ / ~J G~! <br />ON <br />INCLUDING THE B7O-O7O-Z71Z n /~ <br />~~ ~Y `-' <br />1 <br />g <br />s <br />I <br />~n <br />nvironmen <br />BILITY OF FINE AND IMPR <br />P ISONMENT <br />SEE 16 U <br />S , <br />5 1001 AND 33 U <br />C <br />S <br />C ! <br />LLLiii <br />OSSI . <br />. <br />. . <br />. <br />. <br />. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> § 1318. (PeneRias wrier Inese saxu(es may Include Aires uP b 570.000 and a <br />S <br />6 <br />d <br />d OFFICER OR AUTHORQED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED eASSen <br />mw <br />u en <br />5yeers.) <br />maximum imprlsarxne/rta <br />COMMENTS AND EXPIJWATION OF ANY vIUW NUNS (Reference er1 azracnmentfi nere) <br />'~ L`1^ <br />1 <br />~ i l''l l{ 2n° <br />r~, x:~i• C /If <br />r'P ~I![TwV ,f~rl~`TI TTITY t~ ' Ur ..pt r.w ~I ^P'.. <br />T' ')P T •. Tnl)D .~..e T,. <br />..~ <br />. <br />. -. <br />/ - <br />. <br />'~ TV:'PTl!li 4-`• <br />v - NT"<T'-7"7^ S.pT Lr 7°iT ~L aP RTTTC'( :f}T~S••r..4i{v .-Trr~v n~CC - Vin:. TT CT ^(i ./ ^1+ <br />•/ C fl 1 f C f T C r n ,/ a~ <br />^ ~ <br />^ ^ <br />Epp Fonn 332o-1 (08-R5) Previous editions may not be used^ (REPLACES EPA FORM T-40 WHICH MAY NOT ~E USED.) PAGE 'OF <br /> <br />