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PERMITTEE NAME/ADDRESS (Include Faciliry NamdLocarion if Different) <br />NAME ^. Y y', ~ 1.r .Y „1Ai .')PF• <br />ADDRESS;3~NF•, 1r J-j .-r•II ^t.r .~ r^'C•AN PY <br />FACILITY <br />LOCATION <br />.... !~LTV_ L~ ;I.'vr .'~:H.'.?AL. ~?'91r <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDES) <br />DISCHARGE MONITORING REPORT (DMR~ <br />(2-161 D]' 9) <br />,U(;)271s7 nnT a <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM .T ~ •) TO ~ f ~' ` <br />(20.21) (2I-231 8425) (2&2]) (28-28) (30.71) <br />Form Approved. <br />w ~ T ,~ o OMB No. 2040-0004 <br />c ~ n n ., 1,) Approval elrpires 0531-9R <br />., _ ..T.~.T -1,-T- <br />NOTE: Read InsVuctlons before completing this form. <br /> (3 Card Onry) QUANTITY OR LOADING (4 Card Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) 54-61 (3Bd5) (96.53) (5461) EJ( OF TYPE <br />(323 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (~) (~69-s8s 69-70 <br />L :.L ~,+~ u~t'n. <br />F SAMPLE v:, a,-° ;: L: .-,. .. ~ ... r T o <br />' <br />(~ <br />(A ~ P <br />I MEASUREMENT O+ r} ~ O I ~•~ O <br /> - PERMIT ,.:> , ~~'F}. .: ?i(I '. ,:. _~ <br />~ <br />L <br />" <br />;r rLa6NT :.RliS V!! U~ . <br />REQUIREMENT <br />.~ T' ,~; ''•.' $iC?3 '" '.-. ~ ~.. ~.T"wF ~~~:` ~... -... "';/C ~ ~~ -. <br />Y <br />,`~ <br />'L.l:~ L:O nAJrr `7R SAMPLE ( n3) ~•"'!`-".3 M4#?tR'= ~#~^t-s: <br />"~'. '+I' T?.'.RT•PYT :'LiL N1 MEASUREMENT O~ ~, 4f O 3 ~~~~ <br />•` J J `~ C 1 U (1 +~ ERM <br />O <br />M <br />~ (I ~"~Or~-. .. ~y i + <br />+ <br />' ~~ y"'_ a <br />~~ ~'` ~ <br />~ ~r <br />C'Lak:B'" GA055 V4LUf IRE <br />EN7 <br />E <br />, 3UCIJy'~. ~~~~~,~` 1~( ~C^ r ~~" ':'* ~ ;' <br />~ <br />J. L SAMPLE ( 9z) r <br />~ <br />': i:iU •1 L <br />` MEASUREMENT O D ~j)J <br /> <br />.I '.'i1h0 1 <br />4 Q <br />PERMIT <br />O'440?#~ <br />'} <br />BS=1 <br />O6R#'m"R <br />>X##A4~~ <br />~#C4. ~~. <br />. <br />is ?''- <br />1!~Xi,~ y <br />lC (v <br />':F`'i.UEh4 GROSS V~G:1> REQUIREMENT iRST SR'R `ID=~ . #?"~-`• -. m <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .~. '. <br />:p' )*.i• - - .. <br /> REQUIREMENT , <br />~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. - ~- - <br /> REQUIREMENT -~~ r'# _ ~r" - ~, d - _ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. '. .;,, ... .::.. ... -,.. _,r <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ..' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMIUAIi WRH THE INFORMATION SUBMITTED HERE NALLY EJUMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON SIBLE FOR OBTAINING ~ ~ ~7 <br />:ril-rd rriill i <br />" THE INFORMATION, I BEDEVE THE SUBMITTED IN <br />A FORMATION IS TRUE, - <br />~- <br />- ACCURATE AND COMPLETE. 1 <br />M AWARE THAT TH <br />F <br />R <br />BMITTING <br />M <br />T <br />P ERE ARE SIGNIFICAM <br />N <br />INCWDI '9 <br />/ <br />` <br />7712 <br />6 <br />~ <br />n <br />vironmental !r; ~a~er <br />=~ FALSE INFOR <br />A <br />, <br />ENALTIES <br />O <br />SU <br />O <br />NO THE 7p- $71)- . ^9 <br />. <br />- POSSIBILTTV OF FINE AND IMPRISONMEM. SEE 18 U.S.C. 41001 AND 33 U.S.G <br />M SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 4 131 e. (Fereltles untler <br />esa statutes may Irlclutle lines up m 510.000 entl a <br />mex/mum lmpnsonmem of batx6en6moM/u entl5yeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RBlarenCe ell ettaonments here) <br />t&'C :RNAT.n, TTSI j.. crl? it ; '„1 ^"PT:,~+~•.F ~1L?A'i (L7' r'1r) .,, T. [.Y ~..r ~.. ._ ~ ._~v -,1-Y'+ ^r^^rn •.,. <br />r <br />~ N F, A O O;J Pcn•Y n•~ 4c ."cP P1 T•~-, 7• <br />Cy.,IKED• S'^ L. 4. _~ P" ~ .~ F7Z Q4'1 'I 7 7JF TRF'-oe ~ nT'~ !' e C r/~ -T ,• <br />rT V .' f nT.f ry r nr nri ..rss me ^ .r..n rnn-_ p-. <br />Epp Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ n T ,1 ~ / 7 i ~+1 1 ''_ 1 ~ _ ,~ PAGE _~ OF <br />