P[RMITTCE NAM CIADDRC[s (/nCIYd[
<br />Fav7ify Namr/LDCafbn ffdiJJer[nr/
<br />NAME_'..ic _ Y5,'. tld VnLl. _~t I:UIiL .L.hi'R __
<br />wonwESB~i._ 1 :'r: -- 7 --- t. ;" l'i t rt
<br />-L-=-=~===-----
<br />PwcruTV -. _____________
<br />LOCATION
<br />ry ATIONAL /OLLV T1.MT OIICM ARGE [LIMIN I. TIOM SYSTEM (NPDESI
<br />D ISCNARGE MONITORING REPORT /DMRI
<br />zle J i ro '' A J U^ Form Approved.
<br />.:G..~~71_+u .~ (SCc., ~l.i OMBINdT2040-0004.
<br />PERMIT NUMeCR ~M••R F - F~ (F n L Approval expires 630-91.
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM . v,- . TO . - _ il'.~ .i (: Li.]C i.n tip- '~-i ~'~:{•
<br />nn.Tn nzTxl n..r<r ne. n nx.,m Ixn. r. NOTE: Read instructions before completing this form.
<br /> (J Card Only) OU ANTITY OR LOADING (1 Card Only) OU ALITY OR CONCENTRATION FgEOU ENCV SAMPLE
<br />PARAMETER (I6-33) (Slfil) (JB~J) (16-J3) (Jlfi!) ND
<br />EX of TYPE
<br />(31-37) ANALV515
<br /> AVERAGE MAXIMUM UNITB MINIMUM AVERAGE M
<br />A%IMUM UNIT6 6343/ (616N) 169~TR)
<br />-JdLUC'alll~r'/ 6AMPLE
<br />MEABUREMENT '.~:tr.:.:i=v -v-.~;i.~.i I1
<br />( I vi ...-• ~~~~ /
<br />B
<br />H2oo ( ~.L) O ~/~I 2A~
<br />
<br />y ., _ ~,.~ aq~ I °?;~:
<br />.,~'~~%"J Cfil./ ° S'4
<br />s:~rT~ >"
<br />,lak~
<br />:
<br />i
<br />F~r L::
<br />'
<br />~~
<br />~F1 ~ R£QUIRENE(VT ~~~- ~asx
<br />' -:: X={L e <~.e
<br />° .
<br />~
<br />°
<br />~87~~
<br />.
<br />~~ a
<br />b~•
<br />~
<br />~
<br />~ Cl1 '.~ "
<br />~t ~pj~•
<br />~ A
<br />,
<br />L ,.
<br />L
<br />u
<br />.
<br />f
<br />.e
<br />°
<br />'
<br />e $ y ,
<br />.
<br />a
<br />„
<br />. "
<br />i
<br />,«
<br />° I .
<br />k d 6AMPLE i-:~viv:} .:.iav ~J ( ) f'~~ ~/ °~~`~i~=F += ~j
<br />O ( 1 [)
<br />O /~y
<br />/ [~
<br />QA
<br /> MEABUREMENT (r.J ~S r `'
<br />31 G
<br />V
<br />r4l'v ~ L. ~
<br />` 'PERMIT` ~ a m~Y~l`i4 i,° 'f1g0. •.
<br />.~a'"
<br />9 ,YYi : '%' .. ..
<br />
<br /><
<br />`s °
<br />3a
<br />~s• .
<br />iyF°;4f7)Jv3.ilxg ~~g$
<br />?.•F'ree >I .e<'a'
<br />° 'A
<br />
<br />a
<br />'~ .k~~'~~, ~{~~' :,°x
<br />1 c:-
<br />E:'r'L1ri,••i' ~f.0.,~ YAi:;I• ,REGUrREM ENTs
<br />
<br />"a. •. "Q: •¢.
<br />
<br />~ m
<br />° ,.>q. :I!e°s
<br />'
<br />«pa °gg p=$S-{~ 3'L.
<br />,
<br />,
<br />aR~,t°~Is~~
<br />~; ~Jba. O
<br />R e
<br />;~
<br />>'.'°,a
<br />~ r
<br />e
<br />x
<br />A~:t:il!4%~~a'
<br />SU
<br />;e.^ '~°y.
<br />~~," ° ¢a
<br />L1L..u.;, i..~".aL
<br />
<br />JJ~k ,.1VL:.L
<br />SAMPLE
<br />MEABUREMENT .,:
<br />.>=resk ~a>c;:~L,/ ( ) :I:;~aiL<=
<br />~ //,3
<br />~ I A ( Iy)
<br />O
<br />^~IA
<br />i`j.~A
<br />
<br />. J ~-i .. t7 I, v
<br />° °
<br />PL~RN R
<br />'
<br />w ,X/$~-a ~g. Y~++
<br />•~ p~q~a ~
<br />~ c~
<br />'. i~
<br />~ nfJ~,~~b^~~'a !4#~
<br />° x
<br />~}•+.I~aN }. ~• si G. R C
<br />a.°.'«~f±~fID3~II, ~z ,•
<br />~
<br />i•."J'•
<br />~
<br />~r~°~7~`"
<br />L ~
<br />~ "
<br />+
<br />fttOUIRE7,t EliT ep
<br />•a,'s,:
<br />.;
<br />'a°x '
<br />' ti ~~s'n
<br />~':
<br />: ,1
<br />;
<br />~ ~ •
<br />°
<br />~ ~
<br />°r
<br />'
<br />~
<br />~s~
<br />$
<br />; :/ l'<
<br />}° $•[r¢.
<br />{
<br />:.
<br />~'~
<br />
<br />_5 'LC IT
<br />~8i COP;tlL.:
<br />M~
<br /><
<br />°
<br />x:.
<br />_ S
<br /><
<br />•~ w
<br />.
<br />.
<br />~' ~ ri~
<br />,
<br />.71"
<br />1 e
<br />,
<br />Xa
<br />: s ^
<br />S
<br />.~
<br />,
<br />€
<br />.. `$[[vda
<br />, .
<br />i.7L1Li 10:AL
<br />
<br />'
<br />M
<br />BUREMENT 4,-x:::r.::: •~
<br />::Y{I='r::
<br />~
<br />( 4-?x•+~
<br />-
<br />~~•
<br />`3~
<br />
<br />I Z
<br />( 1~
<br />
<br />d
<br />
<br />331
<br />
<br />~ RAs
<br />SU_•k
<br />c JLaU EA
<br />-i ti
<br />3J i ''e•' "°
<br />T ° :=3 ~'s x,('.µSBp r`.-.`".
<br />'YF >4iq~vTe ~ ': Y'~ s~. 7f for ~°e~x b?.. e°
<br />'
<br />3d ~.; •.~° e° x `~~.~~zj °"7. piJ~e
<br />.
<br />.
<br />-
<br />i PERMI
<br />•RvOUIREM E11i°
<br />x ,
<br />_~ c~ µ ~ '¢
<br />a .
<br />x
<br />+ s °
<br />`
<br />61
<br />{'bsi
<br />3
<br />: °.+
<br />Y~~
<br />x~.
<br />'
<br />~
<br />CG/L si a' a ~
<br />4}X
<br />ai` &,"oe
<br />iiYL.ii,ui iJ]: 1.
<br />'
<br />, °r.
<br />9'
<br />
<br />x
<br />l
<br />° >
<br />' s
<br />;
<br />r.
<br />1:
<br />,
<br />~
<br />e Sa
<br />•
<br />~ ~
<br />k.
<br />I
<br />°
<br />. _~i L_. ~L:.
<br />.'
<br />.17 L1 U:.,, v fiAMPLE
<br />MEABUREMENT dY
<br />a.
<br />'.f .-! (
<br />) l
<br />l~. V _
<br />1
<br />/
<br />t
<br />IV/ N~ ( LJ) O I
<br />~ !'~ ~/A
<br /> /` A
<br />L7 J4S U . £RM
<br />3T
<br />. «P 7Pn..°x
<br />w>~Si L'aif "a~ , s. r#~, i:~ _: n y ~~S Kt,~Ep°,°'¢
<br />~ .° ~.. '(ti yea a^ ,. sr°"~
<br />Sr ss re " IFTo yy.. "Ii'/~i' ~~~~,; ,
<br />.
<br />~
<br />Cf .
<br />,
<br />f
<br />-RExDU)nEMeNT,' ~
<br />'.-
<br />,
<br />=RS`,
<br />' a
<br />~°~;'°s ;.. .,, ~<";'a
<br />•
<br />'°:'~~';~
<br />a
<br />' 'r~?4a i3~,:
<br />-~~txsa p°
<br />;aC ~ '!'~"' ['L/L ° ~4~C7~+ t~:
<br />+
<br />Sr.i: CJflIfEATS (irL ~ r
<br />T
<br />, , ,
<br />,
<br />,
<br />l , tl
<br />iuL:.Ci, 'i t. ".'TL£f~6Lc
<br />SAMPLE ?PU~}xLL' ti-~ ~;~;.. ( ) ~v;=:~~;~ //~~
<br />~ l'/ 1
<br />~O
<br />I ( '')
<br />L,
<br />D
<br />3 // n ~)
<br />(LAB
<br /> MEA6UREMENT r 31 ~i
<br />
<br />(1J4J 1 ~1 iJ
<br />xa°
<br />a "'PERM
<br />'{
<br />^..<:?r['1q?ti~Tt~"
<br />°~~r +~~a`.
<br />"y~°, ail
<br />n
<br />.. e~!.t,i;°~~~'S'k°..~,<
<br />.~~ya~~~~~s~
<br />labgp •~$^a
<br />{~•~
<br />~
<br />~
<br />.+.
<br />.® p
<br />4~d6~af~
<br />Se~$;"'
<br />
<br />' <
<br />A
<br />`RECUIREM.ENT° '
<br />°
<br />'
<br />I ,
<br />•''
<br />• `TS+I: '
<br />'
<br />m~. ~ ~
<br />: ~~
<br />`°`
<br />~ q
<br />,
<br />y
<br />.
<br />A~:
<br />: $
<br />°iti
<br />k
<br />~
<br />~
<br />f
<br />' L 1
<br />'i#'
<br />~~" a
<br />'
<br />h O S S Y A L L
<br />c
<br />FFLUr:N'I «
<br />tl •
<br />•
<br />l Q
<br />~ v .
<br />r
<br />•
<br />a"
<br />?
<br />a
<br />~ .
<br />;
<br />!+i a
<br />. :
<br />t
<br />'<
<br />. .k. ..
<br />1 s
<br />~ L ex
<br />,
<br />IL ANL .r ~~cnSL SAMPLE !• p..FM
<br />"y T' #4v+-'Fi ( j :r ri'
<br />i
<br />~ ri ;i ll iii: /~
<br />~/ (
<br />\ _ y)
<br />O ~ //
<br />1
<br />-V
<br />d
<br />Y i~~w).
<br />- MEASUREMENT /\ IA /
<br />/
<br />,
<br />`
<br />L•t.n
<br />7:.(Jh f.YJ~
<br />rJ5:J0 L I- 1. a °.°PER1d iT ,~ r ,.~.,~. $6~st..:xu S s `x#i+xfti},;. y
<br />s~ : ;:. .,'figt,¢~: S
<br />a e~CL
<br />~"(~., ~t ay~° 9
<br />'r ~sas~ ~,I ~1"m
<br />° °~"{ v~i'~1rrp~~i 3}~~<
<br />.°
<br />f e
<br />`
<br />-
<br />'
<br />' RECUIREMENTI• a°xl
<br />•
<br />s 9
<br />sg
<br />'
<br />it=
<br />~ • v ~
<br />°a
<br />'. I~
<br />`~
<br />~
<br />'
<br />~'~~
<br />$
<br />1 .s. qt
<br />~'
<br />~ c
<br />V RL.1:
<br />.LiJ
<br />.
<br />~iT
<br />i'LUL•
<br />1' % ,
<br />a
<br />° e
<br />g
<br />N ,r
<br />. s s
<br />°
<br />>
<br />,
<br />i 1 ~/
<br />, (
<br />t;5~ a
<br />NAME/TITLE PRINCIPAL E%EC UTIVE OFFICER PFNALrv OF
<br />LAw THAT I NAVE PER60NALLT EAAMINED
<br />I CERTIFr UNDER
<br />R WITH THE INFORMATION 6UBMrTTED HEREIN AND BAfiED
<br />M TELEPHONE D A T E
<br />
<br />" ILIA
<br />/rND AM FA
<br />d1 MV INQUIRY OF TNOrE rNOVIDUALS rMMEOIAT(LY RFBPONSIBLE FOR
<br />IEVE THE $UBMITCD INFORMATION
<br />T
<br />FORMATION
<br />I BE
<br />T
<br />`
<br />/
<br />/
<br />j1~~
<br />Ills
<br />Richard HE IN
<br />AINING
<br />r
<br />L
<br />OB
<br />RATE AND CONFECT[ I AM AWARE THAT THERE ARC SIG
<br />TR
<br />ACC _
<br />~~
<br />~
<br />
<br />
<br />'~~ 15
<br />UE
<br />U
<br />NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLVDING %
<br />'/
<br />/ - '/~ _ _
<br />rO - F'
<br />n
<br />•
<br />~
<br />11
<br />'`:I
<br />Environrlental L.:n SC 1 IOOI AND
<br />B v ~ / _
<br />O' - ~/
<br />~ ~F ~7 33
<br /> •qE POSSIBILrtT Of FINE AND IMPR60NMENT SEC I
<br />U
<br />]]USC I I]19 rp
<br />lnr. u.drr IArw namr.n nmv rnrludr /.n.. uy y. Jln an BIGNATURE OF PRINCIPAL E%ECUTIVE
<br /> .na
<br />r
<br />A
<br />i
<br />M
<br />h
<br />d AR A
<br />TYPED OR PRINTED .r•..
<br />lvr.n
<br />m..nf
<br />+Fn
<br />.
<br />ord..r maarnrun, rmFrr.~~~~nr.rrr r./ OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO OAT
<br />COMtAENT AND EXPLANATION OF ANY VIOLATIONS (nrlrrrntt all ullua'nmrnv nar)
<br />r LTENd:L L.^I:~ ~~_.. ~_ -:.Li,. _F.-, 'Cl_~._ (L 7C s rr,l I- ii v...r .L .: ._ _.:-_., ]'.'.I.• ..-r L:.L: ~i _ai
<br />C:.AiMdL. _r. i. .. ~. - (, i'ua u~r-... llr nl'ut ~I:7 ,. .,_ I., h'IS. -.i_ ~ ~: ._ .---- _ _.. .. /, .'I; ._.
<br />EPA Form 332x1 (Rw. 488) Pretdous editions maybe used. (w EPLwc[s E.w rowM T-.o wNICH MAY nor RE usED.l F PARE of
<br />
|