|
PERMITTEE NAME/ADDRESS pnelude Faci(iry Name/Locanon i/Dij(erenq
<br />NAME
<br />dL'J~ "DUNrAIN r,t:Ed':Y, L::.,
<br />ADDRESSD,:,~,,.~A p!) "INc
<br />jaUT ~7UNfY F.O.. :: bS
<br />FACILITY ,`, A t1 . L Y : O ~> L o 4 j
<br />LOCATION
<br />. I1'.r: JEFF' JU.'r~;ii
<br />NATIGNAL POLLIfrANT DISCHARGE ELIMINATION SYSTEM (NPDESJ
<br />DISCHARGE MONITORING REPORT (OMRJ
<br />^n ~n~!I nnn
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM I nl U1 TO v] CI sl
<br />Form Approved.
<br />OMB No. 2040-0004
<br />"IIY04
<br />'' - FI:+AL
<br />;:,-L .LOT STUkAGE TO REU SJAJ i
<br />NOTE: Read Instructions beforeZt3mpleting this form.
<br />nN Ln .
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX of TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALVSlS
<br /> SAMPLE :: t..:7r:; ^ ` ~ :F''::: ~`. S~ 4 ~: : i : {: ;: ( I .r
<br /> MEASUREMENT
<br />JJi UJ 1 .1 I .PERMIT:' -" ~"IP 4+!#At~tr ~ _>K#-tM+4#~ ~'_'` t~;) :` ~ ~ ##+763+0`-`` 4•D i-•. ~ ~ ~ '
<br />r t F L G • A T '; I• ) ~ S 7 A L U c REQUIREMENT -- - ~ ~~ ,I!(E.l~U!'y 7 S'; _. ` X~, p"' ~ =~` ~ -•
<br />;~L[D5, rOI'AL SAMPLE -. ~::°:: r: t: r:.^:t: ;KxC;:': c: ( I~~
<br />" ., a ~; N U t; n MEASUREMENT
<br />,. ~ 1J 1 J (r PEIaMIT Ctg1s469 i~R:Er6dt* r. _i" #1~ItYp$
<br />~ 3$ TU
<br />"
<br />~~''~`
<br />rt'LUf `:r G.~J-i`.~ VALJ; REQUIREMENT ~.~ 30 Vf, DAILY MY ';;/' '.
<br />5; r..1'J ~, !: I'IL~~:A4LE SAMPLE .:::x:r .;:~ ..-x,a r;x-.^r.#:: ( i~)
<br /> MEASUREMENT
<br />,, . •ra 5 L :: u ~ ~- PERMIrt` . ~ ~«aa~«~ °~~~ ~ . >r~:;. - ~ ,. ~ ~: ~ ~!b~T " ~~~oxr £;. .
<br />-`:'LJt+r :-?JSS VALU~ REQUIREMENT rtv~-.; ~ iCY:, f~,
<br />F
<br />1i.. 'H`:AJE SAMPLE .;:a ~~:~ 4:t:«,: is br>a#~;~ %xr ,r:::;:
<br />( I~()
<br /> MEASUREMENT
<br />G , -, ~ b 1 .. U '~EPERMIT ~. _ ~'SrrF# ~, . ;~~?~pFiOt~" ..
<br />.A:
<br />'~ ~..-A;i~P~~4` .~ +7r)K###4 :; 10 k,>
<br />r,i r'LJI(..f GdJSJ VALIi~ REC~UTAEMENT ,~" -"-. - ,. -:.. '. " yyF rat -_ "'.., ;. - -
<br />9
<br />
<br />..
<br />.
<br />:/i.
<br />
<br />_.
<br />
<br />:... _..
<br />I.. ;'(, TOTAL SAMPLE ~ :~~%C:F^ re L: ro .: ,-. - #:;:uO;k'+ (
<br />, f,
<br />(A ~i t' c ~ MEASUREMENT
<br />J 1 J 1 o I ~i U PERMIT ' bbq~'a,. 4 ~'441Itg144 ~ :t ::: •>Qp~frYc#$" ~~ D ~ b ~ D `!~
<br />..
<br />'_:-!'LJ°r!T G4~)S~ YALU REQUIREMENT •': ..: A r D .., :; '" °!,r'<:
<br />:,;~, LN C )7i)UII ':d SAMPLE ( (i 1) +•C :: '.c ;:^ is 'x:: r: ~, ':
<br />'; + ~a J r -r E ~. r ~~ .. ~. T P L.: N . MEASUREMENT
<br />'> ~JS'J I r :1 PERMIT ASPQB'1' 'r e??~~'PU$T"-.. `.+@I'(~4`#44
<br />' 449rbf+# Rr'kslln:; x::. ~ ~ l A M
<br />Fi'LUEr.T ~r Jim V,,{I,p REQUIREMENT ~0 A Abu ~ PGD .
<br />,1L AVD iI'<9:,' SAMPLE ::::Y:: ::: .;= ( =7'1) :p r.: r,-~:.; :: .. ...
<br />:' I S J { L MEASUREMENT
<br />,1 r-,o 1 J J ''PERMIT atCs'i ~4{i ," - ~ E,=I II~OlM C+A'. bp-0t+a¢# :abt~t:# .. .
<br />~
<br />~
<br />r-FLJhor ..:•.7~5 VALUc -flEOUIREMENT -~•- -"- - ~( ,T l1~2 NJ=n, .. t - ~a `
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I Cediy under penalty of law Nat Nis tlocument antl all attachments ware TELEPHONE DATE
<br />-}
<br />~ L v ~ CtJI r'YS E' / prepared under my tlaecrion or supervision in ecmrtlance wild a system tlasignetl
<br />b assure that qualifietl personnel properly gather and evaluate rho information ~ )
<br /> subminetl. faasetl on my Inquiry of Ne person or persons who manage the rystem,
<br />/~ /~ or Nose persons directly responsible br gathenng Ne inlormation, the Inlo+mahan
<br />
<br />1- ~ ! '-~~ F- ~ )q
<br />submitted is
<br />m the best or m
<br />krowled
<br />e and b
<br />li
<br />tr
<br />l
<br />t
<br />d
<br />l
<br />t p
<br /> .
<br />y
<br />g
<br />ue. accura
<br />e
<br />e
<br />,
<br />e, an
<br />comp
<br />e
<br />e. SIGNATURE OF PRINCIPAL EXECUTIVE / 7U ~' JS "7 j Q ~L Z6
<br />
<br />TYPED OR PRINTED I am aware that mere ere s~gmhram penalties for submitting lalse informaton,
<br />inclutlin lha ossibih olfne and im risonment for krgvnn violations
<br />OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MQ
<br />DAY
<br /> . DE
<br />vvnunuv,o niv~cnr~nnniivn yr nrvr v+vvtnv+w lnemrence au auacnnronw note/
<br />i"(.i ~ "^!'A(. ('.;~ LI."L'1~ /LLL '~t .,'.IVi` A~~r Jt^?L:.P.'~Lr :.''LIJJ LLMI1 1s"LI r _ i'r ,r.: ::c:,CIP ?Y' -
<br />.b`' L. A. L, 1a V, FO`t d%~~JIkc,`I'!1;'_.. AIL J ~~j~:.AU' ?_:[%O?'rTNG-SPE' i. H.l.i, P; 9T [. .,'r6L'ir.;++i'LIN+- ~ .
<br />EPA~orlm 3303 (REG 3/JS) ^~rev~bus erg olns may be used. THIS IS A 4-PART FORM' PAGE OF
<br />OU~;•?a/?'177 i-l t~~'_ I
<br />
|