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PERMITTEE NAME/ADDRESS Qnc(rde Fadery Nume/focerion JDi$ercnq <br />NAMES ^q n~7!;; r. '.. 1 r .~;-~• <br />k ~ASDRESS'S T H E ": ]. 7 7 T -~ r1 ^1,r - „e r a y o v <br />A :LF'V']~J C? i71 iti <br />FACILITY <br />LOCATION <br />... " iHi~ .. v ! <br />CI =~ . ual, a'rNr <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESI <br />DISCHARGE MONITORING REPORT (OMR; <br />(tae) !n- BI <br />'71'1?7150 nn^ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM Y+ U_ J1 TO 'i'+ r•. , <br />(zo-zrl (zazsl (td-2s1 Razrl (te-zel (90,71) <br />Form Approved. <br />„t ,„„ OMB No. 2040-0004 <br />Approval expires 06-31-98 <br />(i9'1^ '%1 <br />MT1; T ~n\; •, 'r T1 OAT ^'r. r ., r! <br />M1 `NOTE: Read Instructions before completing this form. <br /> 0UANTITY OR LOADING <br />(3 Ceb 0 <br />51 (4 Card Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 4s <br />( ) (54-61) <br />3 (38~d5) (dG63) (54-61) DC OF TYPE <br />(~~~) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ava.YS+s <br />d <br />6s <br />6&70 <br /> (szml - <br />(s <br />.C":~ ;~Ir:?.. <br />(A :i !'' D) <br />' SAMPLE <br />MEASUREMENT ~.-. ~. <br />~ + ~Zj <br />`, 0~7 . ,n\ <br />, 1 <br />~ <br />,/J' <br />~J <br />i1 <br />?.1145 l 0 PERMIT ? P4 +`~:`,^. im###>?7t. 3s5 T~Q ~("~1~'" `~'~.~`.'~5} <br />_.r"LUt-.'+'I' ~4'7ti'' V\!.itv REQUIREMENT - "r'°°. - .3Q~~` ~,/1`i:- 1lliTa~' iK~. ar`/G ~N~!1l' <br />... <br />',; :" <br />y:);.~ j~' i~•7 N17 ~r~+\ -•v SAMPLE ~ X31 x,..sy~,. ^..~..Y t+-t.•: Y`.` <br />T -i 1+'; T F. k: A *'^ ° N^ n r A p~ MEASUREMENT O <br />~ ~ <br />31 ~ ~1 <br /> r 1 , <br />`.I _1 it _~^ 1 7 I) r ~ PERMIT <br />~ - i~ ~ ' P.-. <br />~~ °a s's' <br />'r <br />" ~ "'~~ ~ 1ft M , . <br />~~ <br />?s L']°,RT :R'1;5 v51,f1~ „ <br />T~EQUIREMEfJT' •~FT-R~`(~~5~ . <br />.,~~Li'!!f~` h~D '+ -';~. ~ <br />~ <br />*5r~. ( ,~ t~:-`. Ml r <br />• <br />.. U ..~+:., <br />1 <br />1 <br />L SAMPLE ~:~ ~ 94) rt~t~..h ._,.z....< <3,r,. F.. <br />~/ <br />~ <br />i <br />5 a A MEASUREMENT / V I <br />7UAL <br />4Jh6 1 9 <br />Y <br />Y <br />GR^ <br />j <br />' <br />' ~,E ~1 <br />~ aaa:Cx 9 es=1 a#S+##tr er#r%IISr~AI tt#11r#tA# '-'.`- ~rd°RE"t <br />' <br />^ <br />ih <br />LtIc <br />i <br />[ <br />?F <br />T <br />::: RE <br />E ENT [If$Y ;11-L *In=f1 F <br /> SAMPLE <br /> MEASUREMENT <br /> ' -PERMIT ~•~~ <br />' <br />~' - - ''' <br /> REQUIREMENT h~ !' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ - - <br />- ~ t%' <br />- <br /> REQUIREMENT - ~' - { " ~5: . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. - ys,,t,( <br />, <br /> REQUIREMENT <br />y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ <br /> REQUIREMENT - - <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILWi WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN; AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDMDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />~ <br />1 <br />=.1=1TJ Yii h,llls THE INFORMATION, I BELIEV <br />- E THE SUBMITTED INFORMATION IS TRUE, <br /> rE. <br />ACCURATE AND COMPLE <br />P <br />R <br />BMITTIN 1 AM AWARE TNAi THERE ARE SIGNIFICANT <br />G <br />NF <br />RMAT <br />ON <br />INCLUDI <br />r <br />70-R7G-J <br />71? <br />6 <br />4 <br />94 <br />,'dironnlentcl gICT1~r•pT <br />'- _! ENALTIES FO <br />SU FALSE I <br />I <br />, <br />NG THE <br />O ~ . , <br /> POSSIBILITY OF FINE AND IMPR ISONMENT. SEE 18 U.S.C.41001 AND 33 U.S.C. <br />N <br />0 SIGNATURE OF PRINCIPAL EXECUTNE <br />TYPED OR PRINTED riat uD ro 5+0. <br />00 r"tl rr <br />mum /mprlsonment of t»AV9e 6 montls entl5utla <br />years.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMEN I S AND EXPLANATION Oh ANY VIULA I IONS (NBIBreDCa ell aRaCOmBntS nBreJ <br />-.~.".1NgT\', r.I"I' 'In r?• r rDF r G7,^pL°a S :'17.iD i {G7' t..•] ~n~rv Y Tc (_ ~ r•-vr 711-H': :10. Tr •rr ~~ <br />+[u~Tl~ Cn~ r•1. ~e n.- 1~1r °'"1 ~4 ~'lI G!T?!'t 71'`v^J_'P 7:'~n Tv rv^ ~c~ -ITT. rr "O•-L rr__.~ ^n nw. `~~ ,. / ... + <br />c •1r <br />:'~ry .Dr T~- n v:•^n;•^T^ r\:vn .r•+n r'\ •./ <br />EPA Form 3320.1 (05.95) Previous editions may not be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ,t ~ ] ] „ 7 ,r , n II ~ ^_ 1 ~ 7 r, PAGE OF <br />