|
<br />PERMITTEE NAME/ADDRESS (lnclyde Faciliq• NameyLOCahon i(Digermr)
<br />NAME dL'J= .'!Jt!:.ALS dN6'6CiY, L5~.
<br />1 t.U7 ~JU t: tY i:Ot. ;i ^9
<br />FACILITYz~4~l.Y :; .1 •?1[,=l'
<br />I nr_ATlnnl
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMRJ OMB NO. 2040-0004
<br />a i ,~
<br />PERMIT NUMBER DISCHARGE NUMBER _ ~ L a 4 . A ~; L , .~
<br />MONITORING PERIOD ;IP-~ ~~~.DI F'U ii ~' TO Hsi) kd$P
<br />YEA° ^v:.'f 'i EAR MV DAY _
<br />FROM UL r!tl ")1 TO ':1 +%1 .'1 ~ •i:i DiSi'ilAfi~" y :;:rk
<br />--~ NOTE: Read Instructions befo!e~LRSrnpleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREQUENC SAMPLE
<br /> EX OF TYPE
<br />PARAMETER
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALrSIs
<br />i' ~'~ SAMPLE - ~; rt F : " :; ^::: ;: t. a ,: ~ .:....;: -t ( 12 )
<br /> MEASUREMENT
<br />J~tJ;1 1 'r 1 '.:P6•RMI`E~.."; kR~.i~#~I '`#4~4##4 x'f~~ ~$.w .~ -: #.VtR+C+R~i:;<. ~t,
<br />,
<br />~Q .~ . ~Sh'U
<br />;,t t'LU:'.~T C iJ55 YAl.Uh. REQUIREMENT, - ~ -vn ...~~_` - Y
<br />.
<br />KA ~ _~,r
<br />,. gp~ ,
<br />d,
<br />`+)Li Ui, Path. SAMPLE ~°tutao .., k,;:*;;r~ ( 1.9) .
<br />. i ~ r Y i) i''.! MEASUREMENT
<br />U +>> 1 1 1 1% ~ `PEAMh~~~~~
<br />~
<br />` ~~.~ .-.
<br />' t~'#~~~#:
<br />- ><ta ~: p ~ ~.~^
<br />,r-y ti" ~;°
<br />~ ~,
<br />#
<br />~LU~'iT i. JS.i YnLL': REOUIRE
<br />Nr `,t ¢~. ,~~+*" ~ '~•
<br />~S:L ;i ;K%. .v.i SAMPLE ~`->r~C' ^(eCr,'.:`. ~..;:>~,. -~{:4':;t; (
<br />j'+}
<br /> MEASUREMENT ~tiy,
<br />J J 55 o L J U <-. p~RMll"
<br />' -~ 91#34i ~.. ~''##0; ,. rp$~: k '_ ;x" a~ ;~."*,.;;€ •
<br />~
<br />•:rrL~~•+r :::z~S'; v:1L.ue: .
<br />E)Ed111R~MENr a-; "'~, ~~. .°".
<br />,
<br />j~)'i, fOfAL SAMPLE :,g..,.: ... ;=t:~ d[i: Yt ~:::: K: ( L~~)
<br />(A c• ,•) MEASUREMENT
<br />J tJ't 'i 1 J 0 ... ~~P~RMYl.. .. .:`ilc;rt" +~- 'b~##>rKt~ ~ : ., .; ~.~
<br />,+~#~t erg, ~ *Q'~a:r.;- °,' ;._ it
<br />•'~~;~LUcfil .S :•.O,ci .i YALU2 flEQUJREMENT y,+.. ..
<br />-
<br />- ... .. ,
<br />'" 3 C) AY:, .
<br />.
<br />;3 x .
<br />)il, 1N C7GDUTT /F SAMPLE ( i,3} ~. ., ... ... .. ....:-rr
<br />C'.-. J P "n C~ T" A N T Y L F z'T MEASUREMENT
<br />ti J 1 .+ '~ ' PERMIfi : A~P~i~T lt$PO,FtL, #~~a~s>xa~ aF?b~t>#q~
<br />}~r ~ ~a#aua - t R
<br />°~1.U'ST Gr?'.155 VALUc QEQh(REMENT~ 3QRA 6YG GAIL! °t:D ~ '~~ `xt ~ .'~ - - kAit
<br />:tt~ ANf" '.; Hr. \;'. :: SAMPLE -•. ( 94) kOk#XrF #Irrkk#.X~ #t##kk -- '
<br />4 :. -; d .4 L MEASUREMENT
<br />I J o o ~ ~ u ~ . ~~pMli a#~#e ~~
<br />'
<br />~ rte... ~ ~
<br />~`' -n B$=1 ;. ~
<br />'' ,r
<br />~. ~;; a~ 1 ~~L
<br />~
<br />>r LLI'NP '"~.i ii '1 .q Lfl6 REQUIREMENT p,.. b O=!'. :+"na -
<br />~' .. $,'- '.v k#= r ~; _, .
<br />. ~~.
<br /> SAMPLE
<br /> MEASUREMENT
<br /> _ - - ~."
<br />
<br />-
<br />'REQUI'REMENT
<br />' . -- -
<br />--
<br />- U: n
<br />,
<br />`
<br />. •~'."
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Ceniry untler penalty of law Nat Nis document antl all aaachmenu were TELEPHONE DATE
<br />
<br />^7 ~ t7 ~' ~ yl S ~PL1y~ prepared untler my tlirection a superv~si0n in ecwrdance with a system designetl
<br />to assure that qualified personnel propetly gather and evaluate Iha inormation ~
<br /> submitted. Based on my inquiry d the person a parsons ahw manage lha system,
<br />r
<br /> Ne iMOrmahon
<br />Or those persons directly responsible br gaNering lha information
<br />~ ~
<br />rl
<br />'=
<br />) ,
<br />tr
<br />nd
<br />N
<br />ll
<br />t
<br />t
<br />l
<br />t
<br />h
<br />d
<br />d 7 `f3
<br />bL " ~
<br />s
<br />.
<br />U. ge an
<br />ba
<br />,
<br />ue, accura
<br />e, e
<br />comp
<br />e.
<br />subm~.ttetl ls,to t
<br />e best of my kno.
<br />e
<br />e
<br />e SIGNATURE OF PRINCIPAL EXECUTIVE /
<br />!J 5 / O to
<br />
<br />TYPED OR PRINTED I am aware that Nere era signiGCant penalties for submining false information,
<br />include the sbili of fine and ~m risonment for knOwi violations. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MQ
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
<br />.:L :;HiiA~h' i"P')S T: 'l':-mac:-. C..".j.F, ~_ '~: i. ~2'.;LY ;A'}~I,ih~. i;r ~~ru~,".'"i?-. ~ -`. 'tI.
<br />"'
<br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. ~1'i o 4 J / q J J 7 17HI 11S A 4-PART FORM PAGE OF
<br />..
<br />
|