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<br />PERMITTEE NAME(ADORESS (Include Faciliry• NamelLOCOnon ijDifJerenr) <br />NAME <br />'.tLJ': ?IJUt.:FIn thcH GY, iY~. <br />ADDRESSp g ;a t' 5 U "1 '1 i 4 F <br />JnG/ ::J~%,~TY rfUAD 5S <br />FACILITY .' ~• N: L( ~ ~ 't i 6 LL 1 <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMRJ <br />^^.nn~vn:l• n. <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM '71 n l ~ 1 TO Q 1 U 1 )1 <br />Form Approved. <br />OMB No. 2040-0004 <br />i l O rt <br />(S~;7ti >;M) <br />S:,-.' ~LUi 5",'OHAGE YC+ FED ~,~'~: <br />NOTE: Read Instructions befole'L'Srnpleting this form. <br /> QUANTITY OR LOADING GUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />RAME <br />ER <br />P EX of TYPE <br />A <br />T AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANw-ysls <br />~~ SAMPLE •:-.tn~,p tvk ~: :fv.w- ... ;: r.::k';^. ( I~) <br /> MEASUREMENT <br /> <br />,/ J d / J 1 J 1 <br />PERMIX <br />#is>r~+0##p~ <br />-4393~~ <br />... <br />...r ,k <br />•~ ~~;,'. -. <br />_#9r#~ED~ '>'^.- <br />~~ ~ ,,,,r~1''r~~t <br />~rF~~f~ <br />.. ..~ <br />- <br />FLU •:~+T GrtJS~ V9LUF. REQUIREMENT r•;.^ ~~.' P -~ . <br />..z4~.~. <br />"~.lLCil :,, ."OItL SAMPLE i":': r.:': f~;t434 41k#t'•#it ( 1~)) <br />} 7, h ~ '~ ,1 4 j MEASUREMENT <br />U t: ~~ J ,7 L J .; ~ ~, PERMIT . -. °.0131#(1. ~ , : " : ~+'~'- _ fi., ^,. P-r~ x . ;'-, P'#r ;.,~'~ ~- / t,""+g. <br />° - - ^ t <br />".k'h'LJ%;T (.')~~ lALi.F REOUIREMENT . `.~ AY"' ,.RI~ - <br />`i 'iLl.iJ, .i i:f TLE4°Li: SAMPLE :C¢ :",-'4.: :< a:~k:;.:k ( ~r) <br /> MEASUREMENT <br />J 7 J S 1 I O "~'P~MI)'~" ~##tFttlAf~1F ~ 'p+Mitp ::~ :• G~ #~" , <br />; ~T <br />~I.E'Lr.' <br />~ R8"P <br />w~„ <br />'~.~• ';- <br />~~ ' ~' L J `~" ri T G n J 5 J. V a L U ; REQUIpEMENT - .. ri ~ „~ . ' <br />..., <br />J::. D %11.:.4 i$ SAMPLE F': t:c .,-, .^ 4':^: :T:kfirF y:.. py_V..+.': :: ( lo) <br /> MEASUREMENT <br />~ :~>>0 1 J U .`:PERMIT':' 'i3+Ott~,7~SRrG' i-fi3C3-- ~F #AI~ <br />~ ~ #iG#### (y <br />~ - ~ ~ R,~~' <br />r ,' ;" L J L : P .~ i J :i S V A L l t E REQU~EMENT ~ ' - - ~ l~" ~'* y •~ r- ,. <br />.r <br />"~ /:-;, .,'Jf.4 f. SAMPLE :,+;: •; •r :: .;: .. firr r,., ,. i /) <br />( <br />(A g c g) MEASUREMENT <br /> <br />J i .; 1 y j .) (1 <br />.'.PERMIT. - <br />", dtXtr}O.Itkl¢`- <br />~-#¢>~#GrIS#- <br />~#C4k 34t • 0 iA <br />4 _ r., <br />~; <br />r I. IJ ? ~. ; ~ ~") : 5 7 A L U c: REQUIREMENT ~ <br />Y O - <br />" _ / <br />J,, lli C:JVi)U I'I J}! SAMPLE 03) <br />( ##fi##+~ #P#### #4'e'### <br />I' 11 E 4 T'I i'+ :" P r y N._ MEASUREMENT <br />,.: J'~ J 1 J U :'PERMIT R~POR!' R14'P k== ,+ ## <br />R <br />'"YLJ?'..P ~ ;7`iS VAL.IZ REC)UIPEMENT 34 a Va ~t .i <br />D L 'R.~` ''D ~ <br />.)i:. <br />. -. <br />: _~T ##~: •-:`;~~ -.. „1.,. <br />;LL P.1D .Rr-~~`. SAMPLE .,-. ^.:: ( iii{) 7: t;: .t ,r +kfi#y,::k~ ~k'k p:}s}:,t <br />J :: 'i A L MEASUREMENT <br />!a Ju!: t .] U 'PERMIT MiY73#'rt ,: 1~ `. .: °:~i ~'-~4~..: --.~. - ._ - k#!! - - <br />'t L'J _.P 6n75:i V.4 •, ';E REQUIREMENT A _ ~ ~~ dn_0 ~ <br />ra <br />~ ~y= _ - <br />NAMEfTITLE PRINCIPAL EXECUTIVE OFFICER I Cenity antler penelry of law that this document and ell enachmeMS were <br />i TELEPHONE DATE <br />, ~ 7 <br />S ~ ~~ W~ / 5 ~~~ ~ prepared antler my tlirecLOn or superNSion In accordance with a system des <br />gned <br />to assure that qualified personnel pmpedy gainer and evaluate the mformation <br /> submrtled. Based on my inquiry W the person or persons who manage the system, <br />G . ~. or those persons directly responsible for gathering the information, Na informaion <br />f ~ t ~ ~ ~ ' "~' submined is <br />to Ne bast of my knowledge end belief <br />we <br />accurate <br />and complHe p <br />~~U ~l ] <br />~~ ~ <br /> , <br />, <br />, <br />, <br />. <br />I <br />r <br />nR <br />n <br />r <br />ittin <br />f <br />inor <br />n <br />th <br />t N <br />l <br />t <br />lti <br />t <br />b <br />l <br />t SIGNATURE OF PRINCIPAL EXECUTIVE / <br />' ' / <br />~ ~ <br />~ 2 Z <br />TYPED OR PRINTED g <br />am aware <br />a <br />e are s <br />g <br />Can <br />pe <br />a <br />es <br />a <br />su <br />m <br />a <br />se <br />ma <br />io <br />e <br />. <br />includin the sibill of fineana lm risonment tar knowin ndletians. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />UVMMtN I J ANU tXYLA1VAl IVN Vh AN7 VIVLAI IUNS (HelelBrlCe all aR2CRmen[5 Here) -- <br />iS ., 'P7T6(. IB;1.+ Lirl1"•'S :ILL tE ..+I'~'?c, Aal ~FTTLt'AcL:• _..:DS LI'1L ;.~PLiill ^;^ <=I~"~., tr, 'h;:C/P dVh"I"- <br />.r'E L. A. L, P:; V, }''.~d Hc~UI r1LNE:a7.;. 7IL Cti::p_}' 9FFC''1'i ~c".-SE'E I. d. I. F, F':: VLI. .-r•L( ... .-Li YI, <br />EPA orm 33 O/7 (REV 3 ~)` Frev(ous editions may be used. THIS IS A 4-PART FORM PAGE OF <br />JUS10/070711-iJ': ; <br />