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PERMITTEE NAME/ADDRESS //nCIIIJf NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM 1 iY PDtS) <br />Farililr A'ame/Cocanml i! Ji!lemm) DISCHARGE MONITORING REPORT I Uh1R) <br />NAME_ ryTM~ `(y _Iy~ ,_______ (1-In1 (17-191 <br />ADDRESS Nn a?~~'IRn.M fL~^2N C?Qp(c -1LN °-c--___,. C~ 9 N <br />___~r,3 s,`~"- SI~~.gLS R~(~N ~T'~=G~1~=__ PERMIT NUMBER oiscRnRCC nu•acR <br />-- aae-o~n1L1.------ten X23__ MONITORING PERIOD <br />FACILITY <br />--'-------------------- YEAR MO DAY YEAR MO DAY <br />LOCATION FROM , 1 TO ~ q 1 T ~ I <br />ATRNt JIM STOVi'R <br /> <br />0^". ~ 00~ ro9siN^D n~cHpG ~ + <br />~I Form Approved. T ( j <br />- ° I N A I OMB No. 2040-0004 ~ t <br />~r~•,JR APProval expires 1031-94 ~ 7 <br />NOTE: Read instructions before completing this form. <br /> !i Cd rd Onll) QUANTITY OR LO l a Curd Onll') DUALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(Jn iJ) /jJ-[,/1 <br />~ <br />(i5-4j <br />J (JA-~;1 (ja-6U <br />NO. <br /> <br />EX FREOUENCr <br /> <br />of <br />SAMPLE <br /> <br />TYPE <br />l.P>-.P71 ANALYSIS <br /> AVERAGE MAXIMUM MINIMUM AVERAGE MA %IMUM UNITS fb:fi Vl IbJbAV l69-%01 <br />OLL A`JD ,REASE SAMPLE '4 :`.Yf t: :': •. O ( ilj) pIY[t?*.'.§ Y>~Yr?§}'' $}fj sS i}',t ~ <br /> <br />VISUAL <br />MEASUREMENT ~~ <br />n <br />BUD66 1 0 YJ PEP.f.11T ~~ry~b# n <br />' 65=1 bri{i111OIR# <br />" ##Al~prrkLl Ytn== flf'TCP.j ISUAL <br />EP LUF.NT G OSS YA REQUIREMENT ^ST' M7- ~ ~ •:' <br />_.: (! 'v`{rt{e} 4 <br /> SAMPLE <br /> MEASUREMENT ~, <br /> PERMIT <br />' <br />' <br />" <br /> REQUIREMENT .; <br />~'. - <br />_ <br />' <br /> ; <br />I <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ^s'' <br /> SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT ,. <br /> REq UIREMENT <br />' <br /> ~ <br />~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ 'l:~•r~. <br /> REQUIREMENT ~: <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT - . <br /> SAMPLE <br /> MEASUREMENT <br /> *jJ'. F §~91 " <br /> PERMIT <br />REQUIREMENT <br /> <br />i. ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAI I HAVE PERSONAII~ Ex AMINED TELEPHONE D A T E <br /> PND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASED <br />y <br />J <br />~ ~ /` ~ ON MY INOUIR'r OF THOBE WDIVIDUALS IMMELYATELV RESgON51BLE FOR <br />OBTAINING THE INFOFMATION I BELIEVE THE SUBMITTED INFORMATION 15 <br />• <br />/ TRUE. ACCUPATE AND COLIPLETE I AN AWARE THAT THERE ARE <br />5tGN1F1CAlJT PENA <br />UBMITTING FALSE INFORMATION INCLUDING <br />TES F <br />PCl/J~,J <br />V e L <br />OR S <br />THE PossIBILITV uF FIN <br />MPRISONMENi sEE IB use § lour AND <br />AN ~ <br />~~~ <br />I E <br />D <br />33 IISC S 1319 <br />llCf 11 <br />IJ <br />P <br />' <br />I <br />dfr II <br />C <br />r •( <br />I <br />Ir• <br />NJ <br />I GNATURE OF PRINCIPAL EXECUTIVE ~ <br /> ( <br />a <br />IIJ <br />IIfS Illl <br />I <br />S <br />I <br />Y <br />YY I/If <br />l <br />f <br />1 <br />1 <br />~ R <br />TYPED OR PRINTED SIO.OIN <br />duJ rr muvmum ImPrieonmrnr v! Fnurrn 6 Inmvhs <br />anJ 5 )cars.l OFFICER OR AUTHORIZED AGENT C <br />DE NUMBER YEAR MO DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (Rd?rrnee :111 dllafhmenLf hrrcl <br />PF,RMTTTE.3 "11JST N;TIFY il'1C7 ?G DAPS Pq7~? '~0 C09BINIMG DTSC4AR,pS-PART LA.4, P~ IV. MONTNLi _°AlIPLS"G FI° <br />PH, FL07 F OEG ALLOV.D DURING P~RID^~ np,L'"~ ?.CC£G"= ATTACH STATEMENT TO '?93. f1?TECTION LIMITS-SEE I.°.2. <br />EPA~Foinh3320~~(-Rey~'94f~J Previbo~s+e"o'illdnsi r~r~tbe'used `-~~~ Y'~ IRET'~ACES~EPA~ORM ~~ZO~WHICH M~Y~IJOT•BEIIJ~ED'.181 n..t /1 ~'~~ UU(1111V sanauu nmP~rGE>-U>SF <br />o0n~9/950829-Og28 7 <br />-_..._:.,:;•..:., :...:._ ... i_..- - ~ :,aft' <br />