|
PERMnTEE NAME/ADDRESS Qndi frWryNr'Lurwlar yDls r.np
<br />NAME SENt:;A CUdL C'J",r rli Y.
<br />.ADDRESS k'. Q. 30A (_'7J
<br />dAYD°Y C:J 91h39
<br />FACAm
<br />LocATION y h Y !.• :.:, C'J `.? 1 ^ 3 ~J
<br />n;~tl: :,hcG' rl:.:dl :+, '°!;;4 AL 7~A!.AG ~'i'.
<br />NATIONAL POLLUTANT DISCHMDE EUMINATON SY4TEM IINPDESJ
<br />DISCHARGE MONITORING REPORT (OMR)
<br />Ct.^11;1UJ11 G14 ~..
<br />PERMIT NUMBER DIxNARaE NUMSm
<br />AT
<br />MONITO.RINGTPERIOD
<br />YEAR MO DAY "~~ YEAR MO DAV
<br />FROM f~,t,;l U, k,` ~;'U1 TO '!1 Uy SU
<br />'~$G:~
<br />1 ii iJ';
<br />
<br />- FI:.AL RUJv:I
<br />;..U'?'~ i,i:': 'TESTING F'UR 0146
<br />$' ~° 1+0 DIS%t1ARGE (~ ~~~
<br />NOTE: Rssd Insttuetlolr bst«i~mplstlnp this 1«m.
<br />PARAMETER QUANTITY OR LOADIN.Op', !~;~ quality or Concentration NO. RtECOfNtr SAMPLE
<br /> ~tcs E
<br /> X
<br />ANA<Yme TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS
<br />TAfRE li`JLd ACL
<br />L~~U i SAMPLE ::}K:SpD pp~%pprt :;;rFrk~;:~^. .:::n :, ;: ( ?])
<br />.
<br />1. 'd d I U D A P 11 N I h MEASUREMENT '
<br />TAMJr 1 U U ::.'PERMIT :~ ..: 'r:?r, :; r::;i~~
<br />
<br />
<br />..
<br />,,. ~,
<br />,
<br />..
<br />'~
<br />
<br />,.
<br />{iC~ti~~i:~
<br />:.:
<br />"GiC..
<br />;~: "~..~:.~~':,'.:-:
<br />:,:.
<br />
<br />
<br />~ .,.-
<br />~ .• ~T
<br />rrLY~ ;[iA1i~
<br />c'- r• ,'
<br />i:. rLLc:~'f GkL.iS VALiJi ~REQUIREMEN7
<br />: ~~
<br />~~:~ .~ ~ : ~: :~ .
<br />~ .
<br />.
<br />>.~1~ >t:~Y.!)E~:. . ~ ~ ~ C,,..~~ .
<br /> SAMPLE 4~a'a~
<br /> MEASUREMENT ,°,~
<br /> PERMI ~ ~
<br />
<br />....
<br />:. ..:..:
<br />
<br />
<br />.::
<br /> REQUIREMENT ~~
<br />,:.,..
<br />, .
<br /> SAMPLE
<br /> MEASUREMENT
<br />t.
<br />
<br /> ...:PERMIT ~ ~ ~ ~~ ~ ~ ~ .: ~ .. ...:. .. '.9s"': ,.;. ~.:.: ~
<br />~~ .
<br /> .REQUIREMENT . .:..~ ~.: ~ ~~~~. ~ :. ...: :.~'.: :..~ `. ~: ';~::',; I. ,::: ,,.: ~. ,.
<br /> SAMPLE "
<br /> MEASUREMENT
<br />
<br />...
<br />~~~~ PERMIT . ~ ~ ~~ ~~ ~~
<br />..
<br />.~~.;
<br />+~::~ :
<br />:`;
<br />;
<br />
<br />,: ... :.
<br />..
<br />:.
<br />
<br />~
<br />..
<br /> REQUIREMENT ~ ~ . ~ .
<br />:
<br />,
<br />.. ~ .
<br />.:.. .... .. ~..
<br /> SAMPLE
<br /> MEASUREMENT
<br /> .,~
<br /> :.. 'PERMIT ... ~ :~. ... ~ ~ ~ .: ~ ~ ~
<br />. ~ «•. v.: ,: _,•~ '~tFtr,::,': :.:
<br /> ~REQUIREMENt .: ~ ~ .
<br />~...: ~ ~. ~ ..
<br />
<br /> SAMPLE ,
<br /> MEASUREMENT - ~ '.~ ~t' ",
<br />v ..
<br /> ~~~ PERMIT ~~:. ~:.. ~. . .~.. .. :~ ~..:
<br />,.
<br />
<br />;'<;:
<br />:.: .. .:, I,.:,~
<br />' ~,..,y...r.
<br />' ..:
<br /> REQUIREMENT' % ~; .
<br /><::.. i+~ ,:.>
<br /> SAMPLE
<br /> MEASUREMENT ~ ~: ~ -
<br /> 4
<br /> ~~:PERAAIT~.
<br />~
<br />~:~j-•':
<br />:1~:
<br />:. ~g+'
<br /> .REQUIREMENT ~ ~ .. :
<br />. .
<br />.:..
<br />53::
<br />~ :.~ ~' :...
<br />'~
<br />I?: ~.::
<br /> :.. ,
<br />.
<br />.
<br />....: .. ...
<br />.. ..
<br />":.i:Y
<br />.
<br />P-.:::: :
<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER ' °t1i r ° °r p`""' ° """"'A
<br />prepnrtd uNer mr dlrarrl°n ermR " d0"'"`"' •nd ~' •"•`b"'""'•^
<br />nidnn in unurdume .IrAu
<br />rrrm drl
<br />md ~ TELEPHONE' ~ GATE
<br />'
<br /> g
<br />r
<br />m avure Ibur quonDN peranM prupedn Plber •M nuNrb IM Infarmrlbn
<br />wbrrJllyd.lsdm mT lnq°Irr nr mr prranapnpu.bn mun
<br />rrbe r
<br />r .
<br />-
<br /> y
<br />n
<br />rm.
<br />rlbow
<br />tll
<br />tl
<br />dbNf
<br />b ~
<br />~
<br /> o
<br />pram
<br />rrr
<br />rnepni
<br />wpnl
<br />rrlnt lM1e lnrormndon, melnrormrllan A.'
<br />C
<br /> wbrNrlyd41n rbe bvr ormT M1n°wkdrr and benrr.lrve, nt<vnre.nM wmpYlr.
<br />I nm...rr un mr.r.r. d
<br />nlnonr
<br />rn.mm r
<br />r
<br />b
<br />lul
<br />r
<br />m mro ~ l
<br />EIONATVRE OF -RINp-AL EXECIdTtVE
<br />'
<br />, ~ l 'L] 2~
<br /> r
<br />p
<br />o
<br />m
<br />m
<br />n.
<br />.
<br />r.n.dwi.
<br />IM
<br />al A' A
<br />TYPED OR PRINTED u
<br />ry rM pmdbnllr ordmund lmprlanmrm ror bia.lnr MNndolu OFFICER OR AUTNOI+IZED AGENT
<br />CODE NUMBER' YEAR MO DAY
<br />V UMMCrE I i ANU LArb.AmA I W A yr nn r vl VLA I I V rq5 (KN1/LOCI N/ IrhC/ITIO ff AI/II
<br />Scc rAitT I.A.4 F':%r, v;.:AIL~ JF T;:S'1' ^kJCFJ~nr.. R:;rJS'I' LONESY DILUTIJN (%'- `FYLUL~hT) s:hICH sr,5 LETt1hL 1'J 5:.~°
<br />JF TS':iT UHdASI.S`!S (LCSU) nNL' hTTAC4 .4CUTF. TOYI:ITY 'T F.CiT itEPORT FORM TO G`1f.
<br />EPa F«m aa2o-t (fit' 3/99) Previous editions may be used. This is a 4-part form. ' PACE ,loF
<br />UD1u4/Uiv,ald"as~o
<br />~z.. .
<br />
|