|
PERMITfEE NAME/ADDRESS pnc(ude Faci(iry NamdLxmion i/Di$erem)
<br />NAME .- „. ~~ :~ .. ~ - tT. .)'o,
<br />ADDRESS`". L ^ ... T e ] ' ~ •-. t... Fr " ~ r ~' 4 ti :' S
<br />.T 1 1 CR,-,. ..T. ; ,~; r-T~ ^r.
<br />r'NL" ,77~ ^D ;r1T~~
<br />FACILfTY
<br />LOCATION
<br />. •C"I Ti o. .fir: i_ ~~'t4 G ~m.7y
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MFDES) Form ApprOVed.
<br />DISCHARGE MONITORING REPOBT (DMR; OMB No. 2040-0004
<br />rz-+Ol nv- 91 ~ A ' ~' Approval expires 05.31-98
<br />']~'t?71`.•11 ~(!7 "_ (7'714 °;)
<br />PERMIT NUMBER DISCHARGE NUMBER ~ _ - r ~• .. ^ l {) TT
<br />MONITORING PERIOD yr-..r T -+rr~~ R.n vnrr)r;• ^o^^v .,
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '1 ')•. .I TO t~' "'S a .t ft~ ~-.-r-^~4-~ ( 1 is r:
<br />aazl/ tzz-z31 [2az51 (ze-zr/ (ze-z91 Goal( `NOTE: Read Instructions before c`ompleUng this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4B-53) 54-81) (38-45) (4B~53) (54-Bf) EX OF TYPE
<br />(~-3n AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS
<br />(ezm) ANALYSIS
<br />(6468)
<br />6&70
<br />..~ ..v I"L 1.' SAMPLE .-: ,;~.~,- Yr•..~r^ ~s..fi,; 1 111 ~
<br />
<br />MEASUREMENT
<br />4 ~
<br />)~ ~ !!DD'',,
<br />VL-~1~
<br />LI; ;Y4 t I' ~ PERMIT ^r:- rl +X@ - $~58' Ra FIttP'r ^'Nf`/ d ~~~r~ ,; ~#p~"
<br />
<br />1•`[. 1^~'L' ~F'~i'; Y°:.7•
<br />REgUIREMENT
<br />
<br />~
<br />~'•`•~° .-
<br />':,`~()~ :.~Fw~
<br />T)ll3'LT RX
<br />"~
<br />~;, ~
<br />- 'r'
<br />( SAMPLE ao;xoa a~aaa~x *~tao` p ( T_~3
<br />y
<br /> MEASUREMENT ^
<br />/ l~ p I ~~J n ~ saw
<br />cOiDU 1 0 ^ faERM4Fa~
<br />
<br />" Z?R ~~i ~ ` ~1t76. 1R '
<br />
<br />" 4r~~
<br />~-,
<br />-
<br />.""L "
<br />u ~
<br />K~"~
<br />'`['F'L[I~4T L: R'1 i ~ YgLO -
<br />EQUIREMENT ~`.". ~ '~•'k ~e
<br />•hr§l~~Ll~ a •" ,,,
<br />t~
<br />If;l ~'~"!
<br />ftf
<br />~ ~n ":
<br />
<br />.L 5,
<br />'
<br />SAMPLE
<br />~. ... c
<br />+F~~., .7n 'y~ /
<br />1
<br />l
<br />( s T)
<br />~ J~
<br />N
<br />'
<br />
<br />%PENDRD
<br />~7
<br />MEASUREMENT /~rl .J rf rv/1 I
<br />1
<br />UGS3D (1 U ,) .~ PERMIT a#91xiR R#it A(~R r4~ R#4'?:X';c 8R$JRT - $A ~~lRfi - 1L ~~~f "A~1.~~, u'
<br />i :~ COh?!ENTS a- L7a "REQUIREMENT ~~~~. AMS nrTl.'i Mx "''/L ~IbB .N
<br />.r Cl. us, 'ro. Al' SAMPLE 1F ~~n=x^ ,`P:G.... .; .. ~,. ;.~ { 1a1 3
<br />D i u° A DY J MEASUREMENT ~ {p Q .3~ 6 c-rl
<br />u(~': 30 l D D PERMIT tt Ol rs## $ :°- f@+60~Ap ~ ~~ 7!1 l TtHET3/ ~~~~~'
<br />
<br />••FFt ()cHm ^.R155 1~ :11=
<br />REQUIREMENT
<br />-..~ t
<br />n~ ...;, :;SF?:
<br />iy...y
<br />'.3Qfl~ 1t 9';
<br />DRL3.T !'t T.
<br />•.-lr
<br />M71f !~
<br />is
<br />yUL. US, ti;.L2L ~9L~- SAMPLE •~: t,; tt 71 ~~3 .. ..h.: ._"=rkrl; { ~~T
<br /> MEASUREMENT yy~~"
<br />1~.~ r--I- ,,//~~
<br />!V fl ~ lU~ /U ~'f
<br />is 1,i4 S O D ~ PERMIT =--'~~~~` rx fiO3COAl- :#Y sM.O'~tlt!!'r'" - $~~IE,'j>hj+ r ~;5 -. . ; - At3 P.~1' R!(q `t
<br />4: :.OM~`IGI~PC n~.: ;:: ~' REQUIREMENT ""
<br />, ~~a? 34~R~ A*:E X ~'~ ~1`~: 'L/T. ~ (gD~'rR €
<br />~I'I. ~Sr ~.~." "L SAMPLE ar,~~, ,~ ..'Xx~~ #R': r. t~~ /t~
<br />~ { ~r')
<br />/
<br /> MEASUREMENT `V' (~ /
<br />' i"'IGI~)
<br />~~SUS 1 ~
<br />PERMIT ' aaai t,-a ~ie+ssraa RE3~Ef3~7 RIkF~lIE`i`' NRT?lkfl ,AA~':`'
<br />":YFLUEAT ;f T=' ":'1T'!' REQUIREMENT
<br />• ~'•`-~~ 30bX ll~; Dlii7 Nx "T./', !lQATA
<br />L (, h'AS ' SAMPLE ': r:~:C o.~...~,.... •,'t •:.; .. _.. ~.Y...~. ( 3 ~) ~1,r7 ~t
<br /> MEASUREMENT N ~' l~1? ~/t ,U
<br />OU:i`~5 1 I~ ~ PERMIT SrAtP yt IIa0 ~.. 7S10t¢'~t:.cQ1 {r(bYi#Ak# (!1 OlITIl1 :~+~~-'
<br />-'r~LLI['~T .;3')i= 'rT[rt' REQUIREMENT - TYST ~Ax "';/T. f;WN?
<br />NAME/TITLE PRINCIPAL EXECIJTfVE OFFICER I CERTIFY UNDER PENALTY OF
<br />R
<br />RH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HER NALLY E%AMINED AND
<br />EIN
<br />AND BASED ON MY TELEPHONE DATE
<br />
<br />- ;
<br />AM FAMILIA
<br />W
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />TT
<br />D INF
<br />RMATION IS TRUE
<br />fi 1.
<br />..118 r4 L;IIL ,
<br />THE INFORMATION, I BELIEVE THE SUBMI
<br />E
<br />O
<br />T T
<br />ERE ARE SIGNIFI
<br />ANT ^
<br />~
<br />/
<br />
<br />H
<br />ACCURATE AND COMPLETE. I AM AWARE THA
<br />C
<br />TH '
<br />' ry~
<br />/
<br />
<br />970 870-27TZ
<br />
<br />6
<br />
<br />24 n
<br />
<br />9
<br />~~vlronmentRl ~YlananeT PENALTIES FOR BUBMITTING FALSE INFORMATION, INCLUDING
<br />E _
<br />J ~
<br /> POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 10 U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
<br /> 4 1319. (PeneMes untler Rrese statutes may Include Ones up m f10,000 entl or OFFICER OR AIfTHORIZED AGENT
<br />TYPED OR PRINTED medmum lmpASOnmerx of betwsen6momhs end5yeers.) NUMBER YEAR MO DAY
<br />OOMMENTS AND EXPIIWAI IUN Uh ANY VIULAI IUNJ (HBtBIerICB 811 atfHCnmBn(f nBre)
<br />A•~''R AT% !.T'!I°- ~]° '"C9 r ce r ~.. r,le >1~nr.Y .....v !_ •9_va ~ ,.r »-^r., ......
<br />.. .4r .PD. S''O a~~. .re '?: T°r PIE 4'J 4•)~•u ~~ n4'T `TP F:.,~tsT q^v~-~, ^"'~ nTT c rr*`±~F'_zrc pn nm,~n^r, c/ Uq ~.
<br />
<br />Epp Form 3320-7 (08.95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) ^ ~ ~ ,/ 1 / r) ~ D LL T ?-l 5' II PAGE '
<br />
|