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PERMITTEE NAME/ADDRESS pnc(vde Facillry NmneJLocanon i/Di$erenq <br />NAME ;'v~1 1;- ,,..,-. ~- - -~ <br />ADDRESS~9I N ~ . 1 r 7:, ; . ,.'e'~r '. . „ : ' ? ~ , <br />9101 ?;;- _ T, CT',.~ <br />FACILJTY <br />LOCATION <br />..^!' ".t{Yi° fem.,. ~Ye 'r`.. '. '. A^,';dz <br />NATIONAL POLLUTAN7 DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR; <br />R-1a1 !n- el <br />^)7'T~7TiR nin n <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM -~ ( "~ / TO "~ ~'~ <br />(zasfl (22-23) ~(ta-ZS) (26-211 (7529) (3W 1) <br />Forth Approved. <br />.. , _ ~ a OMB No. 2040-0004 <br />_ Approval expires OS-31-98 <br />c 1~n •r .7• v^9T . <br />. ~ NOTE: Read Instructions before completing this form. <br /> (3 Card OnyJ QUANTITY OR LOADING - (a Caro OnyJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (48-53) (54-6/J 38-45) (46-53J (54-61J EX OF TYPE <br />(3z~37) AVERAGE MAXIMUM UNfTS MINIMUM AVERAGE MAXIMUM UNITS (sz~/ ~ sa)S 6870 <br />'f. A': C'.i :~ 'l'•n:. <br />' SAMPLE :: r.-:~^•'= ~r?:f~.': 84 <br />O <br />~ <br />~ ( Q~ <br />1 <br />~~ }~ <br />i V E 13 R 3 L F. MEASUREMENT • <br />_ O I I ~ ~ALL1U <br /> pEQM17 ~ ~ ~ a ~ ,~i~~q $~ ~ <br />:y~ -IIE1:'i' .7"1SS '14 r nc ~1EOUIE)EM€NT .F <br />-- ri ' ; :3 K~fF ~ <br />, <br />- <br />?1 Za;~L° <br />~1C D~'T~~i ~C/L =~ 5 ~'ak1'!4- ~~: <br />a~:- <br /> : „ , <br />_ ~ , , <br />- <br />, <br />x i - <br />.. : . <br />. <br />. ;r, \ :-~~(n r fit{ SAMPLE <br />T ~ (17) o'k#«,. .....~Rt y##ct-~ ,~ <br /> <br />'4`1" TH'1 i"?MT "LRT31 <br />MEASUREMEN <br />~ IS <br />~ ~~ <br />-TI u-~ <br /> ~'i~-'PERMIT .'- '~ •s' -}~~~ i ~, - ~ __ ~ Sk}111~t~lIA# ? I e, ~`:! ~ _ ~`~~. <br />_ <br />v.•~nv"T .~°775 9~. (. CIF REQUIREMENT -~Q~~~'~~Qi I}~~~e ~~~~ ~+rl - . <br />'- ' #-'.:.$ _ <br />r~'e: "-- Kr}~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - "1~- - ~" <br />~~ ~ <br /> REQUIREMENT - ~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~' ""' '-.~' " - - '~, <br /> REQUIREMENT ,..3. ,.} _ _ - _ 4.;,, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - u._.-- `. <br /> REQUIREMENT - +- ~:~- - 13- -~". ~- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - - - - - - ~;-y <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />' REQUIREMENT ~ ' ,..-,x <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR Wm1 THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON <br />M <br />TTED <br />N ; <br />SIBLE FOR OBTAINING <br />FORMATION IS TRUE / <br />j r <br />..IcilnYL( WJI)s THE INFORMATION, I BELIEVE THE SUB <br />I <br />I , ^ <br />~ <br /> <br />' <br />~^ <br />) ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICAN7 <br />D <br />NG THE ~~• <br />/ ~~ ~~ j <br />/~- <br />970-870-27i2 <br />6 <br />24 <br />A4 <br />rr)rtrnnrlYp) 11 <br />:a ~TH(TPY <br />V I <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLU -- <br /> POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 7B U.S.C. $ 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL FJ(ECUTIVE <br /> <br />TYPED OR PRINTED 5 1319. (Penetties untler Brew slehfes may Inclutle Imes up ro E10,000 entl or <br />mex/mum/mprlsonmem °I6eMgenBmpmhs errd5 yoere.) OFFICER OR AUTHORIZED AGENT <br />p <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell attachments here) <br />~_ -:R11 ~~' j9-iq`f 1Y°..71+ ~Yi^ ,1n~0°CJY T°'C'. 4 Ip P"1 .1 T. .RrTrta^~-r• r^E` 1•.• 1LT 7rrY•,• n•.. ^nr1~ - •~Y <br />~T:p(,5•: iLf.'^T ~ ~? Dli'i*~ ;t71R, 775A 4`i7 'i71R 6'1°iY'; T°` nr,~c~-rv^ n:•v7'1~_'. .1~ .~ .y-~ , <br />EPA Form 33261 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NO7 8E USED.) n rt 1 II n ~ ;t T ~ tt 1 n_1 S ,, ~ PAGE OF <br />