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PERMITTEE NAME/ADDRE$$ rlgC(Ilelf NATIONgL POLLUTANT DISCHggGE ELIMINATION SYSTEM (NPDES 1 <br />Faailin ~'amc~'Lne.vion i! dillerrgr/ DISCHARGE MONITORING REPORT (DAfR) <br />NAME - y. -..-~. ..')^r_ `•~ ,/ y I61 (17-I91 <br />ADDRESSyr-' {_A•T•~r__ 'j, ~ ., i ~c..Rc <br />t '= Z: T^ U~ v T ? i PERMIT NUMBER f Nu.necR <br />~ -, • 1 : z ; r~ Form Approved. 1 ' 7 . <br />_ r T r7 q ! OMB No. 2040-0004 , <br />- „T Aooroval eaQires 1031-94 - <br />--'-~~-~i''s,'^~ µ.r-- ~`-~="'~fLr 4'7711 MONITORING PERIOD <br />FACILITY <br />-------------------- ~_ <br />YEAR MO DAY YEAR MO DAY , <br />~ <br />. <br />`1_-F _~ FROM <br />LOCATION _ 1 <br />/~ <br />2 <br />-r : <br />` <br />r y TO ~.•~f• !~Q QT ri ~B V. '::' I_~~ <br />- <br />" <br />' <br />-. <br />~~ <br />.1 , Y ~~' l " . R ;u NOTE: Read instructions before completing this form. <br />9 <br />Uo <br />~ ) <br />- <br />r ~o-1n (z-~~) (~4-.; r ~e-?7) r?s ~ <br /> (i Grd OnIV1 QUANTITY OR LOADING Card Only? QUALITY OR CONCENTRATION FREOUENCv <br />SAMPLE <br />PARAMETER (46-53) (;4-61) (?$-43) 146-;.i) (;4-bU NQ~ <br />EX OP <br />ANALYSIS TYPE <br />(.71-.71 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MA %IMUM <br />UNITS <br />lb:dy) <br />(6J-6Ar <br />r69-)p1 <br />. ..+' -.).. ~, •I r ~ - ;..,,h A..,:. _..-: :...: .~#If.x f:, ... i1 <br />I <br /> SAMPLE b <br />( <br />.- ~ s.. s~ ~ MEASUREMENT 1O/~ 1 sra <br /> :; ': :4 {e':'Y II f01)<Ifi#/~ <br />' F <br />$~VR~ A:A4hrt :kf/{f{F .':c ,, cU_ "'~- A~;/ <br /> PEP.MIT ., l ~ <br />. c r r 1 r [` •. - ~~ t REQUIREMENT _y ':. M ly 9 i r w'ir ,~ I^ <br />~~c p1 •~' <br />~`^ ^ 3' <br />~ SAMPLE L <br />' <br />b <br />r. N i - MEASUREMENT Q 1 f 1 <br />A <br />~- rl :^'T +r?: w.. 1: >•'': 1YA Ia Srr }trPn~'!' rJ#dtf Cl vs ... >Arat:tr,-r-r. ,i _ .. '[`R1.X ' 'R.1° <br /> PERMIT <br />f, .1 •l_I, ... .').,:Y Lr ~1 'I REQUIREMENT . ~ 0 n~ ~~~(t lr. T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ,'~' <br /> REQUIREMENT 1•' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~; ~ , <br /> REQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cEgnw UNDER PENALrv of LAw THAT I HAVE PERSONALLY EA4MwE0 TELEPHONE D A T E <br /> AND AM FAMRWR WITH THE tNFORMPTION SlIBMYiIED t-tERE1N ANO BPSED <br /> ON MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPJNSIBLE FOR <br />ITTED INFORMATON IS <br />(` <br />~ 1 \ <br />1 OBTAINING THE INFORMATION I BELIEVE THE SUBM . <br />~ <br />r <br />1_. <br />Q Y ( y <br />TRUE 4000RATE 4ND COMPLETE. I AM AWARE THAT THERE ARE I <br />-} <br />1 SIGNIFICANT PENALTIES FOR SUBMITTING FgLSE INFORMATION INCLUDING <br />' <br />V V <br /> THE POSSBIVTY OF FwE AND IMPRISONMENT SEE 18 USC 9 1001 AND 5 NATURE F PRINCIPAL EXECUTI,E I'I Tl ~ ~ <br /> 6 1319 fPewlries under )hem sramms mil' inrlutlc lines uy m <br />33 uSC <br /> . <br />l <br />mnnmrnl of brlxcrn 6 mombs antl < Icars <br />i <br />i <br />SfODCU <br />W OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br />T ED OR PRINTED . <br />m m~. <br />mum <br />mp <br />a CO <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (RelerenCe all al(a[hmen(s here) <br />'hl' • •~. ~) r~.' ~ o-Lt.° T~rc'^ ., ~.~... ~~ ./~ \ _ +t..-. -.: .. q„T••r r; TT.,T.. ~rT '9 r <br />1 , Fr .. ". - r. ' S ° _ :, V ' 6 '. '. E (' . ] C ' 1 '!' i . s .6Th s~ .. ... . I r ' + T I l D ~ ~ ' { t . <br />.. c~ / <br />EPA Form ss2O-1 (ROY. 9-673) PlEVIOUS @C/I(10/IS may bE used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 ~ j F ~ / U 5 ^ F1 : T _ ~ ~ I1 7 PAGE OF <br />