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PERMITTEE NAME/ADDRESS (Include Fanllry Nmnr/LoCaNnn ifOtperart) <br />NAME <br />ADDRESSU ':: w.r A ~ U " I :~ F. <br />FACILITY 31tiG LY Cff ~91by1' <br />LOCATION <br />n;:N: JF.iF 9U~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form AppfOVed. <br />DISCHARGE MONITORING REPORT (DMAJ OMB No. 2040-0004 <br />.. i ): <br />PERMIT NUMBER - IscHARCE NuMeER F - ` ; '. 4 i. `:• n v 6 N <br />MONIT ERIOD '' ~ ' L : i J f: ~; 1' 0 !:': 'J 4 A S I1 <br />YEAR MO DAY YEAR MO 'DAY _ <br />FROM U CS r)1 JL 1 .';~ q0 DISCN~R6E (~( '~^: r` <br />NOTE: Read IRStTB ns before'CBTDpleting this lorm. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION •~: NO. FREOUENC SAMPLE <br />PARAMETER EX of TYPE <br /> AVERAGE MAXIMUM <br />U{~ITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS "~'~/s <br />r.. SAMPLE !~Cc'x7 a:x rye:: ~x r,x r. it {e r,. CrR {c ( ll) <br /> MEASUREMENT <br />J 0 a U U 1 J 1 <br />,~ ~' r,: ~:: • k,. <br />. <br />. <br />` ze+h b 44rR, ~ . U ~'~ ,~'"~ <br />. <br />c.rF'LUEyf ~;n055 6hLU' ~ <br />.as~* -. <br />{t {c r:ie . . <br />, <br />, <br />Y . <br />w . <br />::JLiD~-i, TCTAL SAMPLE .. .. %~:ntrtr - gne~rsrrtr <br />` <br />( I) ~ <br />'i v `i ? F. !7 J 5 r, MEASUREMENT ` ~_ <br />J ~t J j J I ~ ~/ 4 RR <br />~ <br />~' f! 4 <br />~ rx ~ .. k? <br />4?~ = S: <br /> <br />0 <br />.w. <br /> <br />., <br /> <br />~$ <br /> <br />A!~ <br />""F'LUF.t.T GiJ'i~ Vr <br />L u - .r <br />.. ,~ <br /> <br /> <br />. <br />....- <br />. <br />- <br />~ ~ <br />, <br /> <br />~.., <br /> <br />r <br /> <br />° <br /> <br /> <br /> <br />~,. <br /> <br /> <br />. <br />, <br />'~,; i.I i)~, iF:T^LF: ;. it~ <br />y SAMPLE ' <br />` <br />' <br />; :: ... Y...:;:. .t ;: `':: ,non ( 25) <br /> MEASUREMENT <br />L'u7uS L C' u x, +<~ 4 ~ <br />„ <br />:. <br />.sr~tee~tOr~'.' ;~~~_ ~1!! ~ REPQR'~ ~~ alttlw <br />_7 FLUF:^.T ,aUS[i Yn.. Lf s ? "~`" <br />~ <br />., 'r' <br />t. .. <br />w t _ <br />`~ :ERAS' SAMPLE •r,.. <br />.. .. .: ptrr •,t;: ( :. ') <br /> MEASUREMENT <br />., S `,'; L v 0 ^~~^" <br />^ <br />lR„ 3it0+Y##Nc' <br />.., . ?ti140rO#>p O ':: ~ ;. <,., ,~, ,~ ~ <br />I~ <br /> <br /> <br />~F'LU~"•f GPUSi3 Vwi.U' <br />r <br />~ i`"Y'sr <br />y ~(' u <br /> <br />~ <br />. . <br /> <br /> <br />_ .. <br />s <br /> <br /> <br />_ / <br />~ <br /> <br />""` <br /> <br />.. w <br />+ <br /> <br />q ~ <br />%^. -t'I, "UTAL SAMPLE :;4;~:?„~•, ; ., ... .... <br />.:.. ~... r: :r5': '::: ro ( <br />) <br />i <br />(A=, F') MEASUREMENT <br />!~LU~1', I J 0 . ~ s <br />~~ 4691344 •0 . <br />~~ ~e <br />F'FL'uF'hT :,RUTS Vf!I,U: "`"~ `y`~' <br />~ '.ff _ <br />^~_ <br />~ -' <br />~ : w,. ',KBb`. <br />LJw, h CD4.IUIT i!H SAMPLE ( 't) .?=x;: ;tq r~~. {: r•:;:; .. <br />7; L' T f` E 4 T .. F !: T FL A K - MEASUREMENT <br />'rJUSU 1 7 U ,~~ 't .. 49191Y. qT .;' 9t44'9r46 ~: '['. P.~M1~^! 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( i;i~ yr r;: r:ry 4•: r-r;::e c }r.-. .. <br />'r ~ ti U i L MEASUREMENT <br /> <br />I~L~/J// L CI ~ <br />t <br />IY <br /> <br />k <br />.,4 :', ay ~- <br />~"~" <br />'t <br />~~ ~yfi ~q <br />T4Y .IF ~yy~ <br />YT <br /> <br />~ r y~y~y <br />T~T TTN <br />~ <br />~ <br />I.:r rf <br />~}yy ryayy <br />Bi^L• <br />*,uft`~ <br />i341k <br />~ F'LU".T :.N.J v VAL'J a ~ r. _;, ~. ~-. .•r <br />%ECUTIVE OFFICER I Ceniy undrr penelry of law that 1hh document and atl attachmerns were <br />NAME/TITLE PRINCIPAL E <br />r <br />r <br />d <br />d <br />tli <br />l <br />i <br />i <br />I <br />d <br />i <br />i TELEPHONE DATE <br />r <br />/ ~!! <br />epa <br />e <br />un <br />er my <br />rect <br />on or superv <br />s <br />on <br />n accor <br />ance w <br />M a system des <br />gned <br />~ r p <br />~ <br />I , I <br />j ((~ ~ <br />I W assure Mat qualified personnel properly gather end evaluate the inlonnation ~ <br />, <br />~ <br />~ <br />_ submttted. Based on my inquiry of the person or pereoru who menage the rystem, <br />or Mose pernans tllrectl <br />Aa <br />onsible br <br />aN <br />rin <br />Me IMOnnati <br />n <br />IM <br />natian <br />M ./ <br />~l <br />~! ~ <br />_ .fit^~' _ `G./ c.-?---^-. <br />~r -c~ ' <br />p <br />y <br />g <br />g <br />, <br />e <br />o <br />e <br />On <br />. t <br />~ y l '~ ~ submetetl Is <br />t <br />th <br />b <br />k <br />l <br />l <br />t <br />l <br />t d <br />d <br />tl b <br />ll <br />tl ~~~ ~ <br />/ ~/ U I G <br />~ <br />, <br />o <br />e <br />my <br />now <br />e <br />e <br />, <br />comp <br />ea <br />ge en <br />e <br />me, accurate, en <br />ete. <br />i <br />I <br />h <br />M <br />ifi <br />b SIGNATURE OF PRINCIPAL E%ECUTIVE ~ lJ <br />' <br />am aware t <br />gn <br />at <br />ere ere s <br />rent penalties br eu <br />mihing hake IMOrmation, <br />TYPED OR PRINTED <br />inclutlin Ma ssibili of fine entl im risonment for knowi violations. OFFICER Ofl AIfTHORIZED AGENT NUMBER YEAR MO DAY <br />V V MMtN 15 ANU h~YLANA I IUN V h ANY VIULA l IONS (Helerenoe e// arraChme0f5 herBf <br />._ iJTAL fig,.. LIr.I Te? SILL F.t ;AIY LD, A'J L' `_'ETTi. .r.P'Lt ~)Li G` LI"i: AF:'L: ". i:' °'rf• <=lf~y'r, ZJ99 PRECI4r:VE'i:r- <br />.'. [. I. A. L, F3 V, FUri i{:iji;r~.r". "9F:NT ='IL G ;:FrA°_F, F. [;f'(1?'!'?!!f:-:iL i.R.i.r, P'7 !?L. ~.';TkLY SANFLIhG <br />orm 3/4~ Frevibus a Itio sltSay be used. THIS IS A 4-PART FORM PAGE OF <br />OC663/000717-1350 1 <br />