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<br /> <br />PERMITTEE NAME/ADDRESS O+rL4 FxuiryNaWleranon //D~sap <br />NAM1E ~Yr'r., t cNIF'IJ~c LJr.r',jrcAl lu.. <br />ADDRESS N t ~ u [~ A 6:: <br />66 l.nAlt+ I, LJ O,~g26 <br />FACILITY uYN,~uS tHF'IKc GUkF'UkAiIIiN <br />LocnnoN L~ a l u C U 31 t~~ <br />a l l •. M I i w 14 I .. _ i l l y 11 l 1.,: _ .. L ~.. C U 11 ;- r' <br />NATIONAL POLLVTMT DISCHMGE ELMINATION eYSTEM //NPDESI <br />DI6CHARGE MONITORING REPOfiT lDMR! <br />Z-l6 17-191 <br />,i M 4 ' <br />PERMIT NUMBER DtBCHMGE NUMBER <br />1..--~. <br />MONITO JNG E 9D <br />YEAR MO DAY ~'~ ~ Y MO DAY <br />FROM 'V 1 U ` ~ I <br />.. <br />Form Approved. <br />OMB No 2040-0004 <br />~• uF i~; [:dC D I'J •:1 L.1"AMA ru <br />~fpprovel ~p~Y ~0~31-BB <br />~ULiK IN r1 1 <br />F - F1tiAL <br />Y 1 (. Li l\ <br />i•u+t ftu L1 ~~nani~t +''~'4 <br />NOTE: Reed InetrtlC11o1M before, o pletlnp this form. <br />PARAMETER (3 Grd Onlyl OU TITY OR }~, 'DING ~ 11, On1Y1 QUANTITY OR CONCENTRATION N0. fREOUENCY SAMPLE <br /> IIE591 ~ (5d-611 ~ <br />~ J38-151 !4658 154611 <br />E% OF <br />TYPE <br />I81-371 AVERAGE ~ <br />MA),(IMUM ~ 1)NIT$ ~ <br />INIMUM AVERAGE MA%IMUM UNITS mme]I MALVAS <br />l64-691 159-701 <br />ull AI+:. ~, .._.'. :E SAMPLE 444~dG4 9 #ptM«tl-. :~M %r:41t$ +'p.; ;. ,. •t <br />~L~HML MEASUREMENT ' <br />- <br />Jaut,a t L u Iri~~~.`P.EaJN1T':::i": ..":~>,~I!~.!~:,#~.~!:?::: Q~a: ~~-..''.'i%'~~'~ u] 1 ~ :' i:s.:~ k ..qpH dl )A Rk 1Y t•;•'; .;' 'tif.CJ' Ifi>i-i~W4 <br />L <br />T <br />iU~S <br />ALUE NI <br />ENT;: <br />R <br />E ;".::~, <br />.~.. <br />~ . <br />~ <br />~x <br />' ....;.._... «.........a~ <br />~ ; <br />ul <br />crr <br />UL~. <br />+ . <br />. <br />. <br />1.::~~...; . <br />:: s rR <br />CH rw ~ : <br /> ' Sp(MPLE ~~ <br /> MEASUREMENT , ~ t <br /> .:. ~ ~~ <br />,: .. <br /> REOWREMENT: '~ 1 <br />. '' k.. . <br /> SAMPLE <br />' MEASUREMENT ~ - <br /> <br />: <br />: <br />~~ ~ ~~ ai'~>. <br />2,.. x UjREN1ENT:. .: ;; :::.;°~<.~ :. <br />:~ <br />:.~:<. "::: <br />n . <br /> <br /> ;~A~APLE ~ , <br />. <br />~ <br />:a 'SQREMb`NT ~ <br /> ~ <br />~ <br /> <br />.. .. <br />. <br />i:: ; <br /> <br />,, <br />:. <br /> v,. :.. sr :::.: :.:.... ,..... :. ...... <br /> SAMPLE' ,~. ,p' : <br /> MEASUREME~J ~~P. <br /> . <br />PERMI <br />T <br />. `~ <br />. ~ ~~ .. ....,i:a: <~:: ~::: :..; ayy:. ... . <br />~ <br /> . <br />. <br />. <br />.. <br />.REOUIREME.NT ; <br />.. . <br />~."~ .:~ <br />~ <br />~ ~ <br />~~ <br /> SAivIPL <br /> ASUREMENT :'. <br /> MIT-.<;j:~ <br />~:. :. ~ ~; ~. ::~:: ~:~ .,... ~. <br />...,~,.:: ... <br />. <br />; <br />. <br /> ME <br />3 . <br />-i ..:::::.....: <br /> s Lf$ <br />^ <br /> MEASUREME~~ <br />.: PERMIT:?: ;.~ :. ~:.. ~ ~ .... _...... .. <br />~~ <br />~~ <br />~ <br />~~ <br />., . .,, ., <br />. REQUIREMENT: <br />~~{c ~ ~ ~ <br />~ ~ <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PEN YY LAW THAT AVE PERSONALLY EXAMI <br />TION' MITTED HEREIN; MD B <br />- AM FAMIl1M W <br />TH E <br />N bP(R NED MD TELEPHONE <br />ASED ON DATE <br />AA <br />I <br />I <br />JXDIVIDUALS~'~1MMEDIATELY RESPONSI <br />MY INQUIRY OF TtlOSF BLE FOR <br />, <br />( <br />Richard M(IIs ~ OBTNNING THE INFONMr1T+~ON, I eEUEVE TqE SUBM6T4ED INFORM <br />M AWME THAT TH <br />J ~ ATION IS / i/' / ~~ <br />i <br />ERE ME <br />_ . <br />TRUE, ACCURATE AND CpMPLETE. PA <br />~_r1V1YO11f:ICn~81 Manager':"s SIGNIFICMT PENALT 9 FCCCdddIKKRRRf~~~,,,SDSMMITTING FALSE INFORMATION, IN ' <br />:~.~ , ] <br />CLUDING <br />_ ` <br />,. „ - <br />THEP035BILITV OF RNE MG IMPRISONMENT, SEE 18 U.S.C. I IDOL . <br />. <br />MD ]] 070 RTO- 71 <br />E On <br />TYPED OR PRINTED U,S.C. ! 7 ]te. IPrWtlr. urlw N/A. mwni nYy Mckd~ n,.. w ro <br />.nsnmui,tun MPr/snnv,l orblwArrl6 maneerw 6lwra! i IO,ODO SIGNATURE OF PRINCIPAL EXECI7TN <br />OFFCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS !Re/arenas sl/errecnments oars! <br />ycIlLcAuLL. SJL1uS Llnli I+AIVEU FUk IJYhP141n F`1LCG' LVt'Jf~~ct 1.A.~F Nv iVF Fi,.l rttuUlr2tMEKTS. L.1L L <br />y hL'NJC urcaD SAHPLE ANALYSIS KEJUI kEJ 1F 41 Slult Shield I~ Ld:i l:KVc C. ~r.ikLY SAMi'L IT: t, Iw;il{UCTIGNy-l.~. o, <br />Previous editions may be <br />FORM Td0 <br />UOUnv/`)c1U01'1311 <br />i <br />