|
PERMITTEE NAME/ADDRESS (/ntlude Faciliq•Name/Locanon ijDi(/ermq
<br />NAME R, 6° !i~UNPAI~ ~.vE'R>Y, I4C.
<br />Al1pRFCC~;~:f itn Vii :119.`:
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (OMR)
<br />rn ~~ n~' n ~
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />VFea wen OA`s Yr,•iR mV U,SY
<br />FROM i) . • 1 TO l 1 3 1
<br />Forth Approved.
<br />OMB No. 2040-00f W
<br />i .r' ,1 ~.
<br />~5')`i4 '(Y)
<br />F - '['rAL ~iLn',
<br />Ai'UTE7 .'C TF.STIVG PDN il23
<br />1NOTE: Read Instructions before~ompleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS auLYSls
<br />.. .:7J =TATH-: ayyl: AC' SAMPLE ..::~: ..:. ~~ ~....::: ;: :` .. .. .. ( I})
<br />= `: a 10 U A P `t Y i d MEASUREMENT
<br />A 53.5 1 J U P~BMIty •~!-Oq#t$ ,;~E,tMR# .: ~/ Xiv >' C8R### 7~#### F:' - ~"...
<br />:`
<br />r c L U ;:. t o ri J~ -v Y 9 L ri REOUIF(EMENT - - r. a# a bx~~ _',~.ae .. can: 1 ...~
<br />~ k
<br />,'.
<br />l._~a ~'.."A'i iii[ )ht. r? AC. SAMPLE ~`:;; {: ;: rrf ~}#C'=O:t k::k':': r: .. :....._ ~ 1.~)
<br />+ i"? p! R L f: S MEASUREMENT
<br />~~.: 1 1 ] PERMI~~. ..P##Q#" g~," .• #~y r_..~~." "ilrt0l$MtOrtIR". 9eO4S## =,w-
<br />'
<br />:~~L~.'i',T G"]~5 YAL:). REOUIREMENT '." __ -.:f :-l1~[.:...~~.~$ - L,: °t~# ' -
<br /> SAMPLE
<br /> MEASUREMENT
<br /> P RMl +, . ~ . fi ~, e .
<br />~.s
<br /> AEQUIREM NT ~" ` ~.; x~^
<br /> SAMPLE
<br /> MEASUREMENT
<br /> - PERMIT -.. e - - x' -,`r t ~. r .: .,, k
<br />"_
<br />~
<br /> REQUIREMENT ~ - - " ~-
<br />r,
<br /> SAMPLE
<br /> MEASUREMENT
<br /> =-PERMIT- _ -_ .. .~ ~+..^, it ii ",
<br /> ,
<br />REQUIREMENT ~ - - - ,. ~: °~ ',;--
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT. "- .. ~ f,.. ~ _ u. ~:. .; x} ..
<br /> REQUIREMENT - ~.x, _,: _ ,
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />PERMIT . - .
<br />_, ;":, . .•
<br />.:
<br />.°'
<br />_
<br />~,..-..
<br /> -AEQUIREMEPFT- - -- "- - -- .~~--'`` `?- " '+i
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CenAy untler penaly of law tnel this document and all anacnments were TELEPHONE DATE
<br />_ ~../-
<br />J ~ O / ! U~U YI 5 ~~ ~ preparetl under my direction or suparvis~on m pccortlance wM a system tlesigna0
<br />to assure that qualifetl personnel properly gather and evaluate the IMOrma~on
<br />~7
<br /> submitled. Based on my inquiry T the penon or persons who manage the system,
<br /> or those persons tllrectly responsible for gaNering the inlonration
<br />the Inlorma6on
<br />
<br />F_ • / !)• ~ Y I' ,
<br />subminetl is
<br />to the best of m
<br />knowletl
<br />e entl beliel
<br />true
<br />accurate
<br />and com
<br />lete [~
<br />7
<br />J~l
<br />~~
<br /> y
<br />,
<br />g
<br />.
<br />,
<br />,
<br />p
<br />. SIGNATURE OF PRINCIPAL EXECUTIVE J
<br />.J
<br />/ /J OZ
<br />TYPED OR PRINTED l ern aware Nst there are signifcarx pena:ties to submitting salsa intolmauon,
<br />indudin the ossibai of fine antl im dsonment ror knowi violations OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br /> . E
<br />GUMMtN I S ANU tXYLANAI IUN Uh ANY VIULAIIUNJ (He/e/enCe all aaaCtlments DereJ
<br />,.t S'1.;Y I.ii.J, PG Y:II, ,irt r~o;'AiL' ~~ T':;T F'.'JCi.]1! :cpOti?' L~'.J - ,.T°..~ = _
<br />:_i L::CcAL C1 50 7F i't5T 7!?dANI~",:, R~Y;1 ATTA.!I ACU": t. T"]%LCITY T";iT "r.;}'OR~' °'ra' ~.'~ ~ ;'J:'jr OF P,LL
<br />.....,....~ ".:.. ..,.-_ t ,. Spy,. .~., „: 3a '
<br />t-'_PA Form 3320.7 (REV 3l99~ Previous ea(tlons may be used. THIS IS A 4-PART FORM PAGE OF
<br />OOti3Z/9U' !"i I-1
<br />
|