Laserfiche WebLink
MITT[[ NAM [~'ADORE•• (In[ludr NATIONAL POLLUTANT DIBC HARGE ELIMINATION BYBTEM INPDF.S) <br />Wy NAIRr/LxaNpn I/ dlOrnnl) DISCHARGE MONITORING REPORT (DMR) <br />1N~M)11 f.II YACI') ^'1•1~1+••_111f. !2161 117-191 <br />-- ):T ,+~ I,IIa ~'~I--- - ------ r-:.n1•tfi41 ~InN <br />T.{ ~ A PERMIT NUMBER DuCNwRGE NUM•ER <br />-- , •!,- I ----- <br />---------------------- MONITORING PER100 <br />{1rL~.----------------- YEAR MO DAY YEAR MO DAT <br />4-T~ ---- FROM )' ~ .') 1 '~ ( TO H ~ 1 E^ S ) <br />Form Approved <br />OMB No. 2000'0015 <br />Ire rlI rrr rII rr•xl r» rTl rJE~rry IwJII MOTE: RnA InslrueUon[ MIOr• Dotnpl•Unp tl1Y iOtm. <br />' (J Card Only) QUANTITY OR LOADING II Card Only) pUALITY OR CONCENTRATION <br /> <br />PARAM[T[R <br />usli) IJI~6l) <br />(JN~J) (IbJJ) pI6/) NO FP[OU [NCY <br /> <br />OF •AMPL[ <br /> <br /> AV[RADE MA%IMUM UNIT• MINIMUM AVERAGE MA%IMUM UNIT[ 67fiJ) (•IdB) (60.70) <br /> BAMPLE ~ <br />In ~ V F F 1 III ') I ~ MEABURLM ENT • R A • • • • • r• • <br /> PgMIT 1.1 . <br />(11tH R[DYIRW [MT • * • R • ! • • 4 • R • f • • • .r• • 4 • <br /> BAMPLE <br />1 \IIC{' <br />411;• <br />T~1TP MEA•UREMENT • r • • • f • • <br />• <br />. <br />FFFI 114: 11 Pawn 'i~. tdl:/~ <br />ti Sf• R[•YI•W[E•T • + • M • f • • • • • M ]ti .~ 0 Q <br /> BAMPLE <br />)fV , TI I r ~ 1 MEABUREMENT E • • • • • • • <br /> PpYtT v - I I+/VA ~ ~ Mf.~l ~~~'A i~',S <br />~ ~. <br />(74L, R[OYtll[MpT 4 •1 • f } • f • • • • • i !3 ~ Y i!. <br /> BAMPLE :. <br /> <br />•F Ik I II MEABUREMENT <br />. . . • <br /> RIMI IT. ~ T till a v , [~ . r w <br />° - <br />400 RtgYl•W[EIT k • R } * i • • h 0 • R ' •' ~ <br /> BAMPL[ ~ <br />` R rNF A,1t MEABUREMENT • A' • • • • • <br /> <br />00l •souuasttr • •~ • • a f • • • • ! t w • • • ..L~ ''`' 3~ ' <br /> BAMPLE <br />' MEABUREMENT <br /> ' ' <br /> R[gVIR[YQET ; <br /> BAMPLE <br /> MEA6UREMENT <br /> I[RMIT S -~- <br />~ - . <br /> •[pY1RW[NT .( . <br />;. . <br />II[/TITLE PRINCIPAL [%[CUTIV[ OPIIC[R I CERTIFY UNDER PENALTY OF LAw TNwT I HAVE PER6pNALLV [AAMINED - TELEPMOHE DAT [ <br /> wNO AM FMIILIM MTN THE INFORMwTON SUBMITTED H[REIN AND BA6E0 <br />e 'Cp CN MY INOIIIRY .OF TNOSC INpVIDUALS IMMEDIwTELY RESPONSIBLE FOR <br />G~ OHTAIMIHG THE IMFORMATgN I BELIEVE TMC 6UBMITTED IMFORMATIDN <br /> 16 TRUL ACNRATE wryO C'1MRETE I wM wNwRE TNAT THERE ARE SIG <br /> NEICAMT PENALTES FOR SUBMITTMG FwLSE INFORMRICN INCWONG <br /> TN[ POSSIBILRY OF FINE wND IMPR50NMENT 5[[ IB USC 1 1001 AND <br />33USC 11319 <br />Ihmltvr wdr• IArr rWluler Y mddr pnn u <br />W IIOYDD fiIGNATURE OF PRINCIPAL C%ECUTIVE D <br />TYPED OR PRINT[D . <br />p <br />•Mror marlm.ml pnBnmrnl v/Arluern6mnnlAr •nd5 yrarrr OFFICER OR AUTNORI2ED AGENT NUMBER Y[AR MO DAY <br />•[NT AND [%PLANATIOI~I 01 AMT VIOLATIONB (Rr/errncr aY arlpCnlneMl •rrs) <br />hll I1~S(-11pN(:1 /'141.1/RHFh III'tr 111- Tlll:~ 1<1(+i IL1I'll~ YF ldllll+ M(1.11R~ "4.1) O4y('MAk41" <br />+i <br />i~~~ <br /> <br />p~R <br />I <br />1 I <br />1 <br />~ ~~~ <br />^., I <br />I 1 <br />~~~I <br />1 I <br />rT 37YO.1 IR•Y. 10.79) PREVIOUB EDITION TO BE UBED IREPLwCEB EPA FORM T-•O WNICH MAY NOT BE UBEO.I <br />UNTIL BUPPLY I6 E%NAU6TED <br />