|
PERMITTEE NAME/ADDRESS (!nclude Fan(iry Nmne/Locmion i/Diffecenr)
<br />NAME'' •^ -
<br />A6DRESS717y87 1e~%T '-^"'"I, .^.':t'l`: ..
<br />'(LOO EtiST •r• '~~ ,-~ .^~.
<br />~N;.LewDDn - ~, ,,.L«
<br />FACILfTY
<br />LOCATION
<br />NATIONAL POLLIJTANi DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />R-181 (1 ]- 9)
<br />^~Ri77'iD nom' n
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '-' TO
<br />(2621) (2223/ (24251 (2621) (16291 (30-31)
<br />Form Approved.
<br />;, 4 t , .. OMB No. 2040-0004
<br />Approval expires OS-31-R8
<br />,.
<br />NOTE: Read Instructions befo co Rleting this loan.
<br /> (3 Card On 5)
<br />QUANTITY OR LOADING (9 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 3
<br />(59-61 (3845 48-53) (54-81 DC OF TYPE
<br />(327) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE A I r" MAXIMUM
<br />.. UNITS
<br />; IezmJ ~~ Be13 6370 "
<br />.. v: i.~~iL V11 SAMPLE ....~ F TF?fG',a ... .. ( t,l .. 11
<br />J
<br />
<br />~
<br />~ ,
<br />~
<br />-'
<br />1
<br /> MEASUREMENT - t
<br />"~I'~'(
<br />^U^9:1 0 ?
<br />
<br />~
<br />•
<br />t ~`'~
<br />T i
<br />
<br />~ .$ ,`
<br />
<br />~ "ten/ ~
<br />L. '['; LL's;-'!' ;~f'OSS VI[ I REOUI
<br />EMENT ~,
<br />~ rti"0 L
<br />~
<br />"1 $~
<br />~K~
<br />~ ~#I~L~ r'.. ° TI~~ -
<br /> ~. , ~
<br />~ ., a
<br />!,
<br />-• :
<br />i
<br />a , J
<br />r~:: SAMPLE - 3~OP~ «,. 0.,,.. ~ r ' ~) .. ~.
<br /> ~~ //
<br /> MEASUREMENT , ~ C.
<br />UU4UU L D 0 -
<br />--PERMIT- c^a ~ ~; ;;.-
<br />-- a~-- ~,
<br />~~
<br />~
<br />
<br />:'F'FL7E,T .:ROSS V><!V'
<br />'REOUIREMENT
<br />*''~~
<br />p[~~je}fjt1R ,
<br />~ " ~
<br />`~Qj~~~
<br />en
<br />"=y ;
<br />~
<br /> ,
<br />"
<br />.,~ ul aae I:/ SAMPLE ~: >r ~.:. ,<•~ 4;:-:. 'r nit ..,. ,; r- t f TO) ;y
<br />J
<br />~
<br />~
<br />'~ U i ^ p N D B D MEASUREMENT 7</ ' ' ~v r `" ?~T
<br />'
<br />1 '~'
<br />V C `_• 3 !1 O 0 ] .-....PE K4 B ..^ 4 • .•' a .. ,,:. O .@ PT)°4 9•
<br />, ;• " " 'H~t ,
<br />..C CONNPNTS ~~ U E"' 7,:,yw n+:ni;. d ~40!l #f' ~ , ..':/L AtI
<br /> ~ A
<br />.,, r.U7e U SAMPLE :c r'^~~F~ Li .n FP O+s :.t ~: r..^': '- (r ( • n) r ., ~.
<br />.` r _ ° r :~ D E D MEASUREMENT ~ ~ ~ ~~
<br />
<br />~U T 30 1 0 D' ;PERMIT
<br />~ . , A19aar . 5. 70 , R ~
<br />'}'f'L L'El1T C@OSC ?!! "!
<br />'.
<br />- REQUIREMENT
<br />-. ~.`::".y~""'
<br />^
<br />' +ttenx "Tfl,"B )I 1(.1~« [1~TL~ "' `~~'/! N ' ',~"
<br />L~l.l _ • ]!S L' SAMPLE ..
<br />:[~A4m n n: rr r, [. ;. r, F:. _,y .i" ~( ~5) r ~i ~h ~~..
<br /> MEASUREMENT 'fi"~1.11_11 ~
<br />R 0 ~ : 5 6 ' n ",p
<br />E M17~ ; %~ 9 4fi • ~ " ,
<br />" ~M*'
<br />'~ ~``
<br />~ 1[R P~~'" ,
<br />,~C.' COIi M,'i2. IJ"i '?'LO4 ,
<br />•AEgUI EMENT' ..:: -~" ..~':;.~ ,.,. ';:.
<br />
<br />~ ' "th '"'L ? a' ~"
<br />,~.
<br />• ,
<br />,.~.~, ~nr! ~"
<br />~r lla3
<br />
<br />, "~:
<br />
<br />"
<br />u4 ~, :, :-_ ri. c. SAMPLE s-+, :~su sziCS *'aa~xc ~~.5 - '~, ( '~) \} l '
<br /> _ ( T
<br />~1
<br /> MEASUREMENT ---
<br />'~
<br />n '
<br />U 7
<br />4 ~ L U PERMIT ,~-. ~ ~ ~;~: pT . p <1~' tl6T@~/ ^r,.
<br />'~4~.
<br />7': c V ~ T_ " i REQUIREMENT ~'"%` * ~R~X". ~,'T'3 [?! t'L1' i / [. rA" ~ ,
<br />`,.
<br />:, >. ~ :t°. _' SAMPLE ,.:: ;Yx x.; ~~r^. ^••; r-r: ~t r: ,: ~: r: r.rt~:t •: „i~•~, ( tr) ~
<br />
<br />MEASUREMENT
<br />~'~- R'311
<br />
<br />C0ti5b 1 (1 'S PERMIT +JLO ~ (flT~"A :)[ 3~'
<br />'pOLUER" l,j ,i' (:.^~ REQUIREMENT rr:!. r• T}t5 ~' 1'1 )[.S '•!'/1. ~: V.#T .3~s'
<br />{
<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERnFY UNDER PENALTY OF
<br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSONALLY E7fAMINED AND
<br />ATION SUBMITTED HEREIN; AND BASED ON MY TELEPHONE DATE
<br />
<br />P
<br />i
<br />IiIi
<br />h
<br />d
<br />r INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
<br />I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IB TRUE i
<br />'
<br />.
<br />Y
<br />c
<br />ar
<br />S ,
<br />RATE AND COMPLETE
<br />A ,
<br />I AM AWARE THAT THERE ARE SIGNIFICAM
<br />~
<br />'
<br />~
<br />~~
<br />
<br />nLj P'?t'
<br />F
<br />t
<br />! ~
<br />~
<br />i .
<br />CCU
<br />ES FOR SUBMITTIN
<br />P
<br />INCLUDIN
<br />G FA
<br />INF
<br />RMATION
<br />THE
<br />' ~~ /~-~'~
<br />97~_Q 7~-~7[2 f" `. )
<br />
<br />nv
<br />H
<br />ronmen
<br />a
<br />:
<br />ENALTI
<br />,
<br />LSE
<br />O
<br />G
<br />- ` V ~
<br />T
<br /> POSSIBILnY OF FlNE AND IMPR
<br />N
<br />tl
<br />M ISONMENT. SEE 1B U.S.C. § 70Dt AND 33 U.S.C.
<br />10
<br />l
<br />l
<br />00 SIGNATURE OF PRINCIPAL E%ECUTIVE
<br />
<br />TYPED OR PRINTED ac an
<br />er
<br />ace stetufes mry Inc
<br />nac up m 3
<br />,
<br />0 end a
<br />§ 1319. (Pore
<br />ude
<br />mWmum,mpdconrrrenlW beMeenBmonllu entl5yeere.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence en enacnmems here)
<br />n a.~ '~- ^r~- r ["p[, .. Ci, .r.; It ~ •' -• • rv ~_ 1 YGe ,fH_vp ^C ^('[T' ~ T^
<br />~F:rAT-. LI °~ ;l[. i ~lr ~ .t r• ,v Tv •- ~_
<br />r;,Al yFt• n' `,.R• '• °I~ ~ "!~ ,.! .. i, 7^f%V -1C n~l-tC Or~L'Taca of, r`~• nTi. ~pt'.i r,7.^Pr cn r•T. •. ~,.,. r/ •-''F• O•
<br />I~
<br />,1.
<br />EPA Forth 3320.1 (0&95) Previous editions may not be used. (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.) ~„~ Il ,t / ~ ~ ,~ 11 .,_, ~ ~ 1( PAGE OF
<br />
|