|
PF•gMffTEE NAME/ADDRESS (rncFde Faciriry NmndLoccrian ijDi$ermq
<br />NAME BOY[E ~~':';CnfaT-p~
<br />ADDRESS BOYIE hn. 1 r [~, F
<br />P. b. 90'+ u . i
<br />FACILFTY PASTA
<br />LocAnor~O ar I B
<br />t"-nc VtLL7A" a. .,art
<br />1:".ITL'J
<br />co alv2e
<br />co Rlu2s
<br />IA_ °TCP MI: ~~
<br />NATIONAL POLLUTANTbISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMRI
<br />l246) (1 ]- B)
<br />_ PERMIT NUM ER DISCHARGE NUMBER
<br />MONITOAING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ • TO q T ~~
<br />(ZG21) (z2-z3) (z4z51 I?8-z]) R6z9) (3631)
<br />Form Approved. ,
<br />OMB No. 2040-0004
<br />'" j H O 4 Approval expires 0531-98
<br />(5'14P aCl
<br />" - F7H-1, OELTf~
<br />'~S •l F' Sr'/IM?N° 4RyG TO DF'~'4 THL
<br />NOTE: ReadlristruLYi-ons betorl leting this form.
<br /> (3 Card On y) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 48-53) 54-eT 38-45 4s-53 54-eT EX OF TYPE
<br />(32an AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS ,wALYSrs
<br />0
<br /> leze]) 54-ee 69-7
<br />')IL A!iU CF!F.A°, F: SAMPLE ,.Y#YRG ( 9rl) #r,.#^-R: :`.r h:;AG ?#9R>; :'
<br />V I_.i! A L MEASUREMENT
<br />v v •~ «, 1 D D PERMIr~
<br />
<br />~ lr~TM~e!v'a, ~EI~$et~t~.'~ E:.=1 ~ ?~,et+a~ii~a ~ ° +tiri~tilOr>p~p . ~ . ~~ d ~
<br />~.,
<br />
<br />~` Z` ;.
<br />cFF' tV RO YALU ~iGj~J1l9E ' ;' ~
<br />-,
<br />x ~~=
<br />~
<br />;-- ,^~~-~
<br />4,,-
<br />.,, ~
<br />- r ,,:
<br />• SAMPLE
<br /> SUREMENT
<br />MEA
<br /> ry
<br />'
<br />'
<br />U
<br />j+*
<br />C - I t~~
<br />"~}
<br />~ 4
<br />il 1 F ~
<br />- ~ fir'
<br />~ ~~' ~ ~ ~ ~f '
<br /> y
<br />~
<br />((~~
<br />e,4
<br />V
<br />rT~~
<br />A~
<br />~
<br />~T i. xry
<br />!~
<br />J
<br />C"' f aY
<br />:~ ~A.
<br />i ~
<br />1
<br />4
<br />is C~
<br />f 5:
<br /> -
<br />.
<br />YI
<br />'R• 2. - ~'.
<br />t a- ~ ..I } f
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ,, ..
<br />
<br />~~
<br />
<br />a - +
<br />r z= -
<br />
<br />r+.
<br />.. ~e is ,_. .
<br />~a
<br /> ~ ,.
<br /> SAMPLE 1 - C ~` '
<br /> MEASUREMENT
<br /> PER~IET + •
<br /> i
<br />
<br /> SAMPLE ~~ J
<br /> MEASUREMENT ~
<br />
<br />
<br /> '+~ .~
<br /> SAMPLE
<br />• MEASUREMENT
<br /> ~,-~EiMIT r ^~ ~,; r, ~ ~ t '~
<br />
<br />
<br />,,
<br />,
<br />~;
<br />-. „ , ;~
<br />
<br />~
<br /> ~ REMENT 4(-v ~- Y A.1 -.F t`~
<br />~~-t
<br /> SAMPLE
<br /> REMENT
<br />MEA
<br />S
<br />U
<br /> /
<br />~p
<br />(
<br />PEF3MIT- Fl ~': - ~. i.}.' e•~ y -,y ht e
<br />i
<br />-i
<br />:' F€F T li' '7M .•~
<br /> -
<br />;aEa~n~E~,err ~; #
<br />..
<br />u ~ y,
<br />. ''~ ; ~~~~'
<br /> .~_ .. , ~ , .,, ~
<br />._
<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FAM FY UNDER PENALTY OF
<br />ILIAA WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATON SUBMITTED HERE NALLY E%AMINED AND
<br />IN: AND BASED ON MY TELEPHONE DATE
<br />
<br />~ /
<br />"
<br />"-
<br />~ INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />-
<br />~
<br />' ~ ' r
<br />~ ~ = -
<br />}.'_ THE INFORMA7NJN. I BELIEV E 7ME SUBMITTED INFORMATION IS TRUE,
<br /> ACCURATE AND COMPLETE.
<br />PENALTIES FOR SUBMITTIN I AM AWME THAT THERE ARE SIGNIFICAN7
<br />G FALSE INFORMATION
<br />INCLUDING THE
<br />/
<br />'
<br />1 POSSIBILfTV OF FlNE AND IMPRI ,
<br />SONMENT
<br />SEE 1e U
<br />41001 AND 33 U
<br />S
<br />C
<br />S
<br />C ~ ' ] ] ~
<br />. ~
<br />.
<br />]l, iU• A ~ ~. , , .
<br />.
<br />.
<br />.
<br />.
<br />.
<br />.
<br />roSf0
<br />d
<br />000
<br />~
<br />r SIGNATURE OF PRINCIPAL EXECUTIVE ~ %~ i i , ~ ..~ _ (~
<br />TYPED OR PRIMED en
<br />,
<br />s
<br />•va~up
<br />~mumlMmeM~6elxeenB~rln~n
<br />tl5y OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLA710N5 (Reverence err errecnmems Here)
<br />:;8T1'LEAriLF. illi,IDi LI'•1" A~'r!.1~5 Os'L? I^ C=lOYH•24!E3 P4F.CII' xY°S° IS CLP,?M"D. TF CL3LM 0.PP?nYED FY 'a1CD•
<br />.':'JJ 6 IFG'• LT"~!°•- ~_[* C'IP .,c SppLi.D m,l :1FPOPT2D 'BASJR'""'''TS-SF'" L. A. 2• P," ~ FO° y11RDl:y (`F DRUf.c
<br />E OAF r 0.1 l)&9S~ Previous editions rrfa~ ridt betirSed.' ' ' (REP CES~~ ~ T C Y ~FB S .) ~ ~' '- • ~ • ~' • P ~ ~ • PAGE OF
<br />nOppg/v~p317-'.221 7
<br />
|