|
P[RMITTlE NAME/AODRlf! (/nClYd[
<br />Fec!(ily Name/Loclrbn gdiJ/oenr/
<br />.. ~ ~ ~,,.
<br />-'a __1-_-_-__ _ _ _ =_ _ _ _~
<br />____ 1 ~ _
<br />-ACI LITY
<br />LOCATION
<br />nwn on wL rouurwnr once wwGE euMlnwnoN srsrEM /NPDE51
<br />DISCHARGE MONITORING REPORT /DMRI
<br />7~/6 /7.lfl . ~ . .
<br />PERMIT NUMBER RucNwwcE nur.Fn -
<br />MONITORING PERIOD - ~~
<br />YEAR MO DAY YEAp MO DAV
<br />FROM TO 1 '"
<br />.._ l L - r '
<br />.gyn. n, nva ni. ]<r ne.] . np.]m lmxn NOTE: Re
<br />Form Approved.
<br />°) OMB'No: 2040-0004.
<br />.Approval expires 6-30-91.
<br />. I _ i. I
<br />ed instructions before completinf this form.
<br /> (! Card Only) QUANTITY OR LOADING (I Cord Only) OU ALITY OR CONCENTRATION Fp EOUENCr
<br />S
<br />E
<br />PARAMETER (!6•S!) (JId!) (!H-IJ) (16.53) (J161) NO'
<br />E% of TYPE
<br />
<br />(37-37)
<br />AV ERAOE
<br />MA%IMUM
<br />UNITE
<br />MINIMUM
<br />AVERAGE
<br />MA%IMUM
<br />VNITS
<br />
<br />67fi!) ANAL VS1s
<br />
<br />IbILN)
<br />
<br />169-]U)
<br />1 BAMPLE
<br />EA
<br />U REM
<br />NT : :.: ., ., ...: ( ~ :...': :. -.
<br />'~' ( ~
<br />O
<br />H/ `
<br />C
<br /> M
<br />B
<br />E ~, j • ~~ 7/Af,J
<br />
<br />l ~.'
<br />M4 $34t~°x
<br />. ie;:~' °a
<br />s
<br />°IVika'J>~r•?'F i :-
<br />p ~l s~~'~s x°°
<br />'
<br />L tt bx° "9xF ~ `§'sa ~.
<br />°.°e
<br /> T •
<br />P8R
<br />1¢EqulREef ETiT' Z .
<br />. s
<br />°a
<br />~~'
<br />°'~
<br />~ e
<br />s v
<br />'
<br />'
<br />x ,
<br />: V n L'J :
<br />.:
<br />c-J n -Ua
<br />., s'
<br />~ '
<br />° t.-.• . ,
<br />~f~%}(V.
<br />(
<br />}%t:,
<br />`.. °, ,ti.1;
<br />n~-~~~ ,
<br />•s
<br />:'A
<br />°
<br />~
<br />M
<br />(r L
<br />J., *... ..'irJY.>f ;: ( ~ X:'f=,:;: ~:{' ~ - ~
<br />r BAM PLE
<br />R
<br />T I
<br />N ~ A NA A
<br />. I„t MEASU
<br />EMEN 1 !V YT 'V
<br />
<br />,
<br />J
<br />L
<br />."•~ RM' T%°~
<br />
<br />
<br />E I
<br />°n5$:'i9A`b,~£`ti
<br />e
<br />s~
<br />e~~'ffa~~°' r"~'
<br />
<br />xS' ~
<br />..
<br />
<br />d
<br />A"dix SA~,b: jYV°x'x
<br />n ~
<br />.a 'e F
<br />x.. Y.zp.A
<br />~>'e.ney ~r
<br />`xt .~}
<br />~"
<br />Y""n ..T~y.
<br />i ~N
<br />'
<br />~~~
<br />~s nee
<br />a '
<br />x E
<br />.d4 ;'.: i)j Y
<br />&" ~JF~•k
<br />'6 y~
<br />F~'i°~•
<br />9S
<br />.b
<br />x'~Yr
<br />.
<br />- -
<br />u .
<br />'REQV tREL18NT e e I c °
<br />l<
<br />s.
<br />a ~
<br />,<e -
<br />x+
<br />.n
<br />"
<br />p
<br />'
<br />'
<br />' ^i k
<br />°3
<br />k
<br />x~
<br />°
<br />°a
<br />i'
<br />~f
<br />•° ~s
<br />6
<br /># ~e
<br />" I
<br />~"
<br />~ rt
<br />L.::. G r L
<br />n .
<br />~
<br />l e R
<br />r ~~
<br />.,
<br />1
<br />~1 1
<br />3.x+ s < , ~
<br />.,P
<br />~. ~<.
<br />~ < ., I I ` 4
<br />b .~
<br />« °
<br />. JL~ a..7 ... _ 1. BAMPLE
<br />REMENT
<br />E 'J:: _k :v..:r . . . . . ( ~ . . . ~ .. 6 b ( L.:) D ~
<br />5 I/
<br />r
<br />
<br />M
<br />ASU
<br />30
<br />a
<br />V
<br />`~
<br />1 JJ- °~
<br />~' P
<br />RM •
<br />•:>d::i:'1,:",1-'sz%>,r' mT~}.:.~kyyW
<br />~~l (:::~. x gae',¢~4; aasneS a".' ~~~,`, s s~'mw°gs
<br />.x .e
<br />"'
<br />r
<br />g p ~~e'/<~.~:: m°Y~'So`.~a
<br />.
<br />~ .. n
<br />fT
<br />E
<br />°REQUIR M~ENT ° ~e
<br />'
<br />e
<br />°
<br />'
<br />n` a
<br />aa
<br />'
<br />+
<br />~q s °
<br />a
<br />e d
<br />°
<br />°
<br />`
<br />•
<br />~t LU.. T~1ii).- ~.
<br />a
<br />~ °r', w
<br />,
<br />a :: T: '. gxye. n
<br />, FSis`3'
<br />".k$.'a'~oi'a` si E6'~k >~~`"f.1~~e' i
<br />!;;/1. 'e
<br />s §~.9tf'.Na
<br />.'1.
<br />.` •
<br />'•m-,
<br />.JLJ.USF I ..,~ ., BAMPLE
<br />RE
<br />T ~ 'S •~ .. x. jt.',t ( f L.., ., //
<br />1 - )
<br />N
<br /> MEABU
<br />M EN N ~ 'V ~ 'v l' I, N
<br />545 n'°•reRierir ." •<t."''~:;s:r, ;,S'
<br />~~s
<br />`:°~sE
<br />~ .r~~:,a'
<br />% 'ak;
<br />z~
<br />sL~a~~-A~'< ~>se'i;=.'•;'"°`'''' °R? ~
<br />~~¢tt
<br />~` gg
<br />~ °
<br />.
<br />.. ~ 'Rp4U1REM EN'T. ,
<br />,
<br />1 >,n s
<br />' .
<br />#
<br />6
<br />e
<br />~ { s
<br />~
<br />~
<br />~ ~'s.• y~
<br />~
<br />C01' i
<br />:L
<br />c
<br />.'
<br />x
<br />e xYFaa°°
<br />•• ,
<br />•`~8{B~
<br />eE~~l$x
<br />n ,
<br />`8l
<br />LP. /f T~.'.S.'S +w' l'. r./ °~f i i~~
<br />'~~kF
<br />,L•
<br />~Ji)•.DS~ .. .1,: .. BAMPLE :"t
<br />:.
<br />•: .... t ) i}S/Y: J?i.
<br />' ( _1) 1
<br />I
<br /> M EABU REM ENT ,~
<br />O
<br />-
<br />I G
<br />0 •' O ~(
<br />~ I`I
<br />li 7 1
<br />J "• .ei?ERM~tT "` °'lL~~~TJ
<br />~°
<br />( '„.~&'
<br />''+'~~el~~. s
<br />R ~ C=: %. e`
<br />a~al.~~fl°: *r j
<br />,~
<br />r
<br />a x'~~PA
<br />Sd
<br />wi•
<br />°.~ g
<br />' e'
<br />a
<br />~~(.I
<br />~Y~
<br />a m (~
<br />)
<br />~~
<br />°
<br />J
<br />7 ,`=•~ Yn~~e
<br />°
<br />`
<br />x
<br />~
<br />r
<br />J >RHOy1AEt11 £f1.T,i a
<br />°~`~ • ,
<br />e
<br />;+ .1
<br />,~
<br />p
<br />`°
<br />' F S
<br />,
<br />,
<br />,'-mx:~ •
<br />6
<br />1
<br />' ,
<br />e
<br />!
<br />e
<br />.
<br />:x
<br />~' %~
<br />"' .ar .
<br />a
<br />.
<br />'
<br />..L;, .,
<br />w
<br />,
<br />6}'t~~J~R; .,riG V0.LL'[. '
<br />.. '' " a ,
<br />.
<br />.•
<br />....
<br />° M V :::} 1
<br />1
<br />.
<br />x ;
<br />i nL L
<br />;.:
<br />NL' ;:
<br />LA
<br />:LL +:C>k tti`;: t+:7: ~#r.`a:: ( ~ .:;A4.'„ 0~:r t}~xs ( 1`J)
<br />.
<br />,
<br />n
<br />, BAMPLE r~/
<br />A
<br />NI~ I~'
<br />A
<br />A
<br />-l.( ~~ .(_(!~.„~ ,"1C MEABUflEMENT 1) ILI
<br />~
<br />' ° •P
<br />Rf1
<br />'
<br />« `a.,i~i3t:'fina'%a`x$a' ~>i°k7'".Y,a
<br />•-f1'#.+~ li' a=E:F~'f$'Y'~ ~°= ' "
<br />,433?~'•L=anjQ~+'';"1' ~;. ~.`•; ,:':A:.°.na;.
<br />~'
<br />~
<br />: n''S Fi'~.~':,pp qq .
<br />`A g ~ pa",.
<br />~~rP
<br />~ i L
<br />r J
<br />I r
<br />1T
<br />E
<br />~R6Q(71RE ENf , ; . x~
<br />. , .
<br />~ & k .
<br />~.
<br />
<br />~.T .~: r -V IL 9AMPLE
<br />MEASUREMENT =F{ ..A;.I ( ~ 11 ::[..
<br />N ~
<br />N ~~ ( +`~
<br />NA I'
<br />N
<br /> n
<br />
<br />
<br />' ,-
<br />°P
<br />M
<br />T•` ~
<br />
<br />"?~~w~:~i '~A
<br />~
<br />°
<br />
<br />~~; R x°dgk'x~x"~
<br />`~
<br />
<br />: •.:.
<br />
<br />~;s. r.`'
<br />;...~ %~
<br />
<br />
<br />~'' '
<br />g.~ g„4 q ,°
<br />~•"
<br />° t4
<br />
<br />
<br />k °q~e
<br />1. kp<
<br />r ~;~'"
<br />`~
<br />
<br />J«,Y
<br />~xL r . y
<br />4
<br />I L - "
<br />/
<br />ER
<br />,REOUfyEM~6:NT° ,
<br />,
<br />x ,
<br />r
<br />s a, ea~x
<br />•
<br />`°
<br />• . °
<br /><
<br />snx.
<br />°
<br />~ !
<br />.,
<br />n'
<br />~
<br />3x
<br />x
<br />d° x
<br />x
<br />c
<br />~
<br />a ,
<br />e °
<br />`
<br />m « y ,
<br />`
<br />I „
<br />,
<br />,
<br />t
<br />x
<br />: 4::.::,
<br />.
<br />%
<br />~
<br />9
<br />.¢r ~i
<br />`x 1~~~
<br />w
<br />s
<br />x"~€iP 4.~
<br />•~
<br />~
<br />~.,
<br />~ 3 ~.
<br />s
<br />RAME/TITLE PRINCIPAL EZ[G UTIVE OFFICER I CEgTIFr uNOER iENAITr OF LAW THAT 1 NAVE PERSONAUr Exwww[D
<br />NFORMATION SUBMITTED NERCIN AND MSEO
<br />fA
<br />I
<br />INq WITH THE
<br />-
<br />^' TELEPHONE OAT E
<br /> r
<br />nND wM
<br />M
<br />L /
<br /> ON YY INOUrRr OF THOSE INPVIDUIrLS IMMEOIFTCLV RESPONSrBLE iOR , /
<br /> OBIAINNVG THE INFCRMATrO`!. r BELIEVE THC SUBMITTED rNFORMATrON
<br />I
<br />AWARC THl1i TNEPE
<br />IRE 51G / /
<br />/ / / /
<br />T
<br />~ ~
<br />;!I•' IP I'^~ '~•Illr
<br />• ~ T
<br />r5 TRUE ACCURATE ANO COMPLETE
<br />AM
<br />InCLUpNG
<br />T PENALTIES FOR SUBMITTING FALSE INFORMATrON
<br />Fr4 ~
<br />/~' /
<br />
<br />l .
<br />NI
<br />N
<br />TY OF FINE ANO IMPpI50NMENT SEC IB USC A 100, ANO
<br />SSrB ra
<br />r ]I (
<br />('/r'-~~ 1, 1
<br />V'~
<br />~J
<br />rl'
<br />~•••'~•1 rJ/1fr
<br />Fr;T/~~Qli i.-T :l THE PO
<br />rLI
<br />,Nrurrn ••P nrldr /mr. uv r•~ ///I/}II
<br />]7 USC A 1J19 sR
<br />uM
<br />r rAr
<br />g fIGNATURE OF PRINCIPAL EAECVTIVE '
<br /> v.
<br />m
<br />r
<br />v
<br />A
<br />ds
<br />A A EA
<br />TYPED OR PRINTED ya..~
<br />mnnl
<br />. an
<br />a•d,..ma.rmum rmpnnn,mn~r .~/n.m«n OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENT AND EZPLANATION OF ANY VIOLATIONS Ine/rrrnrr m! mmrnmrnu nrrry
<br />1.4.. :1 .I. _ ., L..- . ~-.• L:'.V .. ..~.. _.L:. -. .... V-. (L'... EI EJ .. •.~ .,.•..V .. ~~_ .. - I ~ _ _...... ~ • .-L
<br />EPA ForiA 9320.1 (RBv: 9•a8) Prsv/duf aditlons`may'be b3ed.' '•" " a~ ~IRE~LACFf [~i1 FORM T-Sf WNICN MAY NOT \[ YfCD,) / /AG[ OF
<br />
|