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•ITT[[ NAM[/ADDRFJL (lRrludr NATIONAL POLLUTANT DIBCNAROE ELIMINATION tYtTEM (NIDFS) <br />By Ndly/LDr•rioR i) dl01nR11 DISCHARGE lIONITORING REPORT IDMR) <br />1i T~Ir1111ar~ I(aclN vltiltil~. 11r ___ (z~ls) rn~+s) <br />f - IrT 7- n-PIk Nal------------ flloU th\S1 I)~,' <br />T N ~ ):) (~ A ~1 PERMIT NUM^ER DuDHwncE NuMSEw <br />I 1 7 <br />L.. ` -)- ~)~---------------- MONITORING PERIOD <br />YEAR MO DAY TEAR MO DAT <br />a~~~~__~____-____-__~__ -- <br />FROM 7l 5 u l U I To Il 5 1 T ;1 <br />I~-T1~+~-------------------- r <br />/+f u, N+n/ N.a)1 r»~D/ I+fD/ ru~+U NOTE: RLLd IntlnletbnL hLlon eanDltWt IhY bNn. <br /> () Cord Orlly) OUA NTITT OR LOADING (/ Card DRIi) OU ALITT OR CONCtMT)IATION <br /> <br />-ARAMtT[R <br />(IE-7l) 171-0I) <br />()d-1!) 116-0!) (hill NO <br /> <br />LE FR EOUENCT <br />DF OAM-LL <br /> <br />TT-[ <br />(!d-!T) A ANALTtI• <br /> AYERAO[ MAAIM UM UNITE MINIMUM AY[RAO[ MA%IMUM UNIT/ 6J-0l1 (M-0L) IYD-70) <br /> LAMPLE <br />TN 11 ~ ~ I. 111 "I ( I MEAN p[M [NT I • A • • • • • f • • L <br /> -tdWIT rLl1 ~ 'y~ <br />U Il <br />M--,ter- R~q IUOI/11T <br />-. <br />rLi,L~z <br />d~.. ~ <br />,- ~.R. ~f , i f <br />. <br />~4 r f <br />.-• - ~ <br />R .f <br />~...: <br />' :.~T~ - <br /> . <br />UMlLI , <br /> <br />1 Oti+ IIIT iII VII ~I11 <br />MEMUREMENT r <br />f • ~• • <br />• • <br />hFLUI N11 -aEEtt ( n/n~ M~./L <br />S 0 RwuuwwT . • t t • « • « • • • • ~ • 7 ~ r { ~ C <br /> LAMPLE <br />NE IIIT nI• MEALUREM[NT • •~ • <br /> <br />tt <br />RLOI FLlfodwT <br />I <br /> <br />F <br />I n/I~1 <br /> <br />- , <br />hll;/l <br />.yw <br />`: <br />s <br />U 4 5 .* • t R •' <br />t A • R t • i S I/ Y ~~ <br /> LAMPLE <br />•` 1f ( )1 MEABUREM ENT • • i • • • • • • • • • <br /> p1 -~ .`J 11 <br />~ i:. w ~ a ~ ~ "~ <br />0 U () ~1/T <br />R[qu RI f • • f ! R • • h 11 R R • '. L' !~ .~ ~. " v +~. .. A <br />~ LAMPLE <br />I <br />~ 1.1~ ( l: ~~1 MEALUREMENT • • • f • E • f <br />Sll4(- MRYIT +4 111./I t ~' ..m :b <br />"` ... <br /> <br />nut RLOU1RwLNr <br />. . <br />. <br />- . . <br />. . . <br />. ... <br />~7n '. <br />~, . <br /> SAMPLE <br /> MEASUREMENT <br /> ~ ~ - <br /> rLRrtt ~' a : <br />. <br /> RLOYIRwa1T •~ R <br />~'A <br /> LAMPLE <br /> MEALUREMENT <br /> <br /> <br /> RNIUIRWwT ~ ~ • <br /> <br />~ _ <br />~1~_ <br />~ ,,.~ <br />[/TITLE -RINGIPAL [%[C UTIVL OF/IC[R I CERTIFY UNDER 'EIULTY OF LAW THAT I HAV[ PERFANALLY F%411NED <br />IAR WITH THE INFORMATION SUBMITTED HEREIN <br />AHD BASED <br />AND AM FAMI I TELEPHONE O A T [ <br />L : <br />L <br />ON MY INg11RY dF TNOBL INDVIWALS IMMEDIATELY RE..PONSIRLE Fpl <br />pJ <br />G. M1 GM1 OBTAINING THE II(FORMATION. I BELIEVE THE SUBMITTED INFORMATdf1 <br /> IS TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG • <br /> NiICAHT PENALTILS FOR SU9ARTING FALSf INFOPMATION <br />INCLUDNG <br /> . <br />TIIE POS51&uiY OT FlN[ AND wPR1$ONMENT SEE IB USC. 1 IOOI AND <br />33 USC 11319 Iq II <br />der Iher rMluln <br />indldr /w. <br />o b E/Row SIGNATURE OF PRINCIPAL E%EC UTIVE <br />TYPED OR PRINTED y <br />µ <br />Nr un <br />rM/o. mar~m.m ~mnn.onmrnl P/•rlwen6monlA.uMSye•.../ OFFICER OR AUTHORIZED AGENT A HUMB[R Y[AR MO DAY <br />Form ApprovBd <br />OMB No. ?QD400/5 <br />I~~ <br />I~ <br />I ( <br />~P~ <br />1 I <br />1 <br />1 <br />~'~ <br />1 <br />1 <br />rrM <br />:. ) <br />I <br />I <br />MLNT AND E1rPLANATIpN pF ANT VIOLATIONS lrtr/osnrs aN (lnurnmrnu nrrq <br />rll ;I~Lf ,It1 R1.1 lel'fuhr,l n . I1v 11,IC Iril hf I .,.:1 ( I. 1'FI 111~~ .,I r:~~ T "'ll l)Itif rlgkl;l " <br />n <br />OF <br />rm 3320-1 (Rav. 10.79) PREVIOUe EDITION TO BE USED (REPLACER EPA FORM T-10 WHICH MAY NOT BE UBED.1 <br />UNTIL SUPPLY IB E%NA USTED <br />