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PERMITTEE NAME/ADDRESS /Include <br />Farilify Name/Loralion if diRercnl) <br />NAME ;. <br />ADDRE+~SSf'-'e~s.Lb~-b~ Lx-v~ ~.". ~L1 ~ - - - - _ - - - _ <br />• ~+ ~ . , 7 <br />FACILITY ' <br />NATIONgL POLLUTq NT OISCHggGE ELIMINATION SYSTEM /NFDES I <br />DISCHARGE MONITORING REPORT (DMR) <br />;~' ~ 11.1 <br />PERMIT NUMBER HAgee Nu~aeP <br />~ MONITORING PERIOD ~ <br />YEAR MO DAY TEARI MO DAY <br />LOCATION ___________________ FROM y9 -~ `I TO <br />.`.I1iUk <br />(S U i1 ii h a) ~°S u ggproved. <br />F- F I 4 A L OMB No. 2040-0004 <br />AP~Ploval expi es r10~ 31:94 <br />rU9U :il.a-!{nx +. LU ~l.>I L,Kr-h <br />NOTE: Read instructions before completing this form. <br /> (.7 Card Only) QUANTITY OR LOA G !d Cdrd Only) QUALITY OR CONCENTRATION FREQUENCY <br />PARAMETER (46-SJ) (54-61) (J8-45) (db-G7) (54-FI) NO. <br />EX OF <br />NpLVS15 SAMPLE <br />TYPE <br />(J1 J7) g <br /> AVERAGE MAXIMUM NITS MINIMUM AVERAGE MA%IMUM UNITS <br />161Li1 <br />(dJ68) <br />(d9-f01 <br />a'J L 1 v J . T'J I n L SAMPLE Y,: :;:'::~ C1 . :.: .... ~. ~ <br />: .,... .. '' ( 1 y \ <br />/ ~ / <br />.y} <br />" , <br />~ <br />/ <br /> MEASUREMENT n^ ~ ~ (7 /I,~~`l '/ <br />_ I I <br /> ~ <br />~ <br />J i °~ J L J v PERMIT +1 Kl ii##fi ~ Ar~~Y~lSI ~ :., ~. ~ T~~A~ Y <br />S. ~,'M=tR~~A~ ~LT ~i . <br />~: <br />1$. <br />' <br />' <br />• REQUIREMENT . <br />f, j; t: <br />; <br />r <br />. jIC' V <br />' <br />~ ~ <br />/1L nilV uI'i.1JL SAMPLE ( <br />•d4) ... :~Q$::}s}:} G:}%F ~: ;.: .I 1~ <br />' O <br />[ 1'I <br /> <br />i <br />iU:1L MEASUREMENT <br />I~ ~ / <br />I V ~<A l l <br />. <br />KUOU L 'J V <br />PERMIT <br />#f}Qfy a}r} <br />$~I <br />IGbrJ r}Y:} <br /> <br />'F V'CIO <br />~ <br /> <br />IG Ail ~}s'f YS IP 'V <br /> <br />J'::;: u <br />EKL~Y s~ <br />SD~L <br /> REQUIREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ ~'.'s'.° <br /> REQUIREMENT ~'},~ ., <br />~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "~ <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> I ., <br />~"~ <br /> REQUIREMENT ;{~~ ~. . <br /> SAMPLE <br /> MEA~IIREMENT <br /> PERMIT '~,' ~~' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I cERTIFT UNDER PENgLTV OF Law THAT I HAVE PERSONquT Ex gmwED ~ TELEPHONE D A T E <br /> <br /> <br />Ri <br />d Mill <br />h 4N0 PM GPMILIAR WITH THE INFORMATION SUBMITTED I-IEREIN: AND BgSED <br />ON MY INOWRT OF TFIOSE INDIVIDUALS IMMEDIPTELY RES~NSIBLE FOR /' <br />, r. l <br />I ~ <br />r <br />ar <br />s <br />l '9 <br />l OBTAINING THE INFORMPTION I BELIEVE THE SUBMITTED INFORMATION IS <br />TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE I <br />'l~ ( ~ / `!f .' : <br />-r q <br />97~- 70-L7~2 <br />~ <br />r <br />~~ <br />~ f <br /> <br />m7,rlPnta <br />anac~er <br />~w <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br />'~ <br />1 l <br />- THE P059B1uTY OF FINE AND IMPRISONMENT SEE 1B USC 4 1001 AND SIGNATURE OF PRINCIPAL E%ECUTIVE <br /> <br />TYPED OR PRINTED 33 USG S 1319 (hnaPirs undrr rhrsc sulmrs may lutlc (inu u/ ro <br />SIOp(kl anJ or maslmum 1mOrlsonmenr of beru'ern d nlonrhs and 5 )rars) <br />OFFICER OR AUTHORIZED AGENT AREA <br />COD <br />NUMBER <br />YEAR <br />MO <br />DAT <br />COMMENT AND E%PLANATION OF ANT VIOLATIONS !Re@renre all auarhmenls nere) <br />,Jia, ~ li.:i:n~L v':nd 56,IFLt. LyUI.1C.J i?' VCC:PL:. `:+.. .. .. I-i vD:i:..:cJ - 5~.. I....1. (;i) CcTiCTION LItITS-SE(3 <br />I.i'.1. onLIN1:Y i1U\1T_1Jrtlfib - .iEt I. n. 3. ~i+.hLY taA:~k'LiNii LiJ3L':~DCf1JHS I.:;.iVp•H:.E'OiYT k]SULTJ ON NAriCa~ <br />EPA'FarrR 3320~1yReJ.9 f3 )`Pre'y/ tions• 'y d~ d. Iie~PL'Aees d dR'dlk- O fEH iiAll''sIJO 'BE F1 ~Er].IL" U L V R l • PAGE OF <br />OG.i3y/95021 a-1361 2 <br />