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PERMRTEE NAME/ADDRESS (include Facl(iry NamerLocorien ifDi$ermt) <br />NAME 'v ;, ,. _ .r, -. "_ -~~ ~, <br />gpDRF <br />~Sfyi4/.` )°:: <br />l ~ ....., <br />.. 5y c.; <br />s ~ ~ <br />l . <br /> <br />FACiuTV <br />LOCATION <br /> <br />~ l i M i l J L p <br />T J 1~ . ~ <br />r Y I •- p. i ~, T~ 7 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCIlzAR GE MONITORING REPORT (D1MR~9! <br />~]'1 )?711 '!-'l A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ' ~ ~ ' TO ~ ~~ <br />(24211 (2223) (2425) R&2r) (2&291 (30.31) <br />Form Approved. <br />~ ., . OMB No. 2040-0004 <br />Approval e>rpireS 05-31-98 <br />(: ttnp , :) <br />_ c . , A . e. . T. . <br />NOTE: Read Instructions bef a completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 4653) 5461 (38-45) 46-53 54-61) EX OF TYPE <br />(~3n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS tsz~! a(vyr~e l3 69-70 <br />.• L'Jn~ 16 l_' ~'_, IL ~ 'ti SAMPLE 71) .. ..~...~.. ., t.t ~... ~.,. <br />I'~!;~~I TF. I.ATf7 P'+1* Ts !,R V MEASUREMENT <br />~,I1:15o 1 n ~ <br />PERMIT <br /> <br />~ aa+aalr~ <br />A <br /> <br />~ fS~FI:Lr <br />ii?F•f.43A'T i`17S i Y i i.l?' . <br />REQUIREMENTS _ <br />~A ~.~)t' <br />' =~~~j.~ K; :!1 5 - <br />. <br />y - .- - :''T F^ "s' <br />.i l: 1.l ~~~~ t !;~ L SAMPLE •ax .- :~sa~~: n iY$tG>=~` ~ Tql <br />'I' 'HOLY`; .) MEASUREMENT <br /> ~ '~.: <br />I- '::.. A ~ . <br />: <br />~ # <br />~ <br />~ ~ ~ <br />` <br />P <br />,:.°D~ii V4r r.l <br />;rf•c.cE:NT AECII)IFi <br />EMENT , tt~^ A's t <br />' ` ~~ <br />y !;)~.~~t. ~~ ".1•/1 i` <br />+, )$T1~' <br />~~ <br /> SAMPLE <br />f I:i .~ A L MEASUREMENT <br />~'1Ufl~+ 1 1) PERMIT ~ ;P R4;•;, °$=1 :t~0 rTC :. >ftArm vR 49r1h~+R0- S~S~tt .'~~' .. <br />;; F'FLUENT ~:~?;S VALO ,REQUIREMENT ~T~t3.1" ~~.~" H0=0 ~ ~ - ~ ~ - ;`~a'~` <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br /> REQUIREMENT t- ~, - <br /> ,,, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br />~ ~'~ <br /> REQUIREMENT - s .~ ~ <br />~ _ - = • :; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. . • .. •, , .. ~ .. .. <br /> REQUIREMENT - - ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ • ~`x~ <br /> REQUIREMENT .?~;-, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF <br />AM FAMILIAR Wml THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND <br />ARON SUBMRTED HEREIN <br />AND BASED ON MY <br />/~ TELEPHONE DATE <br /> ; <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ` <br />/ / .~ ~Jr <br /> <br />''IC aHY(~ i-~ <br />I~)S <br />THE INFORMATION, I BELIEVE THE SUBMffTED INFORMATION IS TRUE, ~~ <br />~/ <br />/ ~ <br />j <br />f <br />. ACCURATE ANO COMPLETE. 1 AM AWARE THAI THERE ARE SIGNIFICANT <br />DI !/ <br />/ <br />/ <br />~~(%~~ /J <br />q] <br />~ $7O-Z~II~ <br />+ <br />JI+ <br />9 <br />_ <br />',-J1V'I~i ll!'IFlltal '•:I;~c:ger PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLU <br />NG THE _ • 1 ~ <br /> POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 1B U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 4 1319. (PoreNss antler Vase alelutes mey incWde Ilirec up ro ff0,000 entl or <br />melimum lmpdsonment or bensen6morX/u entl5yeer5.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (RelerenCe ell errecnmenrs nereJ <br />... ., .. .fl`:A= ~^ ~ r/. ^ 1. °?ri l~ n'T" TT l'.. `~.. _ ~• ", n'1~ ^er ~ O. -~ .TT•r ",..sT~ <br />... T.5 - f~J"1Tv l*- /~ "1; •~']iT"'7^jX' i°r ~'1grr:. I, ~Cl„ "lA ~.. :f *T~•eY rr ^. 1. <br />EPA Form 332o-1 (05.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,t n ~ c ,I ~,T .. O D T ~ _ t c r,l PAGE OF <br />