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PERMfTTEE NAME/ADDRESS Rklude Facillry NomdLorvrbn ifOrffamr) <br />NAME <br />~LUt ~UO:;TAIti ::ht~cr, I~i~. <br />ADDRESS-;_II~ll '-~I/;}ADD "'!i '+i; /~ r~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />w I l: J ~'. <br />T .., <br />P RMIT NUMBER DISCHARGE NUMBER + - ~ T !. n L <br />Form Approved. <br />OMB No. 2040-0004 <br />Ri~L4h <br /> <br />'++'.~~LY CJ n1':~:~ MONITORING PEIOD ~': ~`UI ~.7'.%p '1"! Hrv aA~' <br />FACILITY <br />LOCATION YEA MO DAY YEAR MO DAY __ <br />' <br />FROM O1 05 U1 ':TO .'i >I ~ ~ ~ "ci LISC?Af.G= ~''~' <br />e p <br />~ ` <br />lating this form. <br />NOTE: Read Instructions befor <br />A T f '.: J E F t' D U o •'~ ; ~ :; '' <br /> - QUANTITY OR LOADING ~. QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMET <br />R EX oP TYPE <br />E AVERAGE MAXIMUM UN MINIMUM AVERAGE MAXIMUM UNITS ,wALrsls <br />i `% SAMPLE :r ~:-~:'t :k is t: L+. +: {';'c ( 12~ <br /> MEASUREMENT <br />;I , u U U 1 D 1 {.. ,~ terra S 4t <br />~~ 4 r 0 K~ 85 F! <br />:Ft'LUi•: ~T 't J.. ': r.L,J .~ ~ ro~~*~ ®,.4M ~t0 I tlUy q, MII ~'. 'r <br />S:1 Li D:;r "nl'AL SAMPLE .. ~ sr,.pR r,::i: :::' ( I'?~ <br />i~ l y P E ti I~ t.'; MEASUREMENT <br /> _ <br />cr r'L'J E:'~T GHO55 VeLn' <br /> <br />- . <br /> <br />.. - ~ `~ <br /> <br />T' ' V^ <br />Y <br /> <br />. <br />" t <br />J : L !; ,; ii L 1 5 £ SAMPLE ... , .... .; ... <br />.. .:.:.::: R # ~ Sr L' yi Yr C::: ~fO <br />( <br />1 ;~ ) <br /> MEASUREMENT <br />o'J 5 `a ~ 1 D D T~.,ix -~ a.~~r>q~- ~ v>atsax~gE ... ~~ ~ ,~ ~~ ~~4 - ~- °' ` S~ it R~~ <br />' <br />:ttuUE.',T GdJ55 J.ILL'• ~ 4 ~~ <br />.. <br /> <br />~ 4 <br />°. ' <br />" c~ <br />i '~ J > , T 0 f A L SAMPLE ~ ~ ~ `" `"'= <br />'~'~ ( I) <br />(,5 ~-, }'g) MEASUREMENT <br />lI1Ju~ 1 U 0 ., ~~'#kt4lgl#~c 4Ctrt1&:irtr ;t#~4tii4iFf <br />4 ~ <br />- <br />~. TaU '"` '1~' &'r` <br /> <br />" <br />~ , <br />+ r, i ~, <br />:.FFLJt.~~T Gass vaLU~ ~t <br />-:. = <br />~ - y ~:t: '. <br />' <br />t'LJ'wr ,4 CDt7DUIT OF <br />SAMPLE <br />( +? '.:.:' :yo": y. ff •F •:.': ': is ": 1,::;r i::p <br />~'ra f'+r:gT!1F,hT PL:.!: MEASUREMENT <br />S;1JS~ I D o " -~" ~ .A£POkT a*aiae - . t~:0aaart: ~Ip-i~#cl~c .. ~SRLX kS~A <br />i.FFLJchT :.dJSS VA. L!1 ~.G , <br />~ , <br />.. <br />J ? :. A •i :i G r{ h' A 5 E SAMPLE :.`..:~ .} ...,.. ( -. ~,) ..:...:...:. <br />.. a.4'i :: :l .: <br />Y j 5 J A L MEASUREMENT <br />H 4 J ~ L 1 U () ~ '#„ gr.~t:k .: _ _. <br />~ #4#Ot## tOt¢¢li!0 N r Y ~x. .2, <br />`.FFL'UE'rT GRO55 4ALU .+ ~~ y,•~f~ <br />~ii5 i3R6 " '_ •.~ 1` ~:• ,, .; a- .;+ <br /> SAMPLE <br /> MEASUREMENT <br /> A ~'~L ~ <br /> 2ffi'T1v. ,s ~ ~ ~ ~ r r L ~m ~Si. x. <br />NAME?ITLE PRINCIPAL E%ECUTIVE OFFICER ICeNy untlar penalty of law that this document entl ell anachmenls were TELEPHONE DATE <br />prepared untlar my tlanction or supervision in attrordance with a system designed <br />/' r .i{~ to assure Net qualified personnel properly gather and e'valuete the ~nbrmation <br />l ~ l S V ~ <br />~ ' <br />rubmmed. eased on my inquiry of Ne person or persons who manage the system, <br />J Q ~ ~ ~ <br />r ` <br />the inlormatlon <br />Ne inlomiatlon <br />onsible br <br />atherin <br />tli <br />Tl <br />res <br />N _ <br />~ ~~' %~ <br />~ <br />, <br />g <br />g <br />or <br />ose persona <br />rec <br />y <br />p <br />f-- l - I l: submmetl la, to Ne best of my knowledge and belial, we, actuate, end complete. <br />SIGNATURE OF PRINCIPAL E%ECUTIVE _ <br />I em aware that Here era sign?rant penalties br submiaing lelse Inlormatign, OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED PRINTED krclutling the possibll of ane entl im risonment for knowin violatiana. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />:IL !: SnEA~e: lt:P')'•.TIhC:-5:'.t: I.U.1.Fr i'; :']7. :'7"r,LY JA."'pLI!:G TI':'f`~':C.:Io~:?-I.C.~r F%; XI. <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. THIS IS A 4-PART FORM PAGE OF <br />~Ueuu/U60717-1350- 1 <br />