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PERMITTEE NAME/ADDRESS (/nclude NwrloNwL PaLLUTANr DlscHw RCE EuMINAT1oN srsTEM (NPDES) <br />F~rlllry N~mep/Locs(lon /! dlll'eren!) r1 ,! DISCHARGE MONITORING REPORT (DMR) <br />NAME-,( 4TFg~~'~Aj,i ~y-Q1: .F1U~+-f-v_:A.L.~--- (J-I6) (/7-/9) ail ~1 l;'H ~ 1 <br />ADDRESSaYEl1~'iQ3L'~t'L1I'~' -----_---- CCIJOUGLI.'. C07 .+ (SUi1R liC) ijgtgrAV~ovad. ' <br />- ~ - Fj r1A_B.Q~L ( lj - _ _ _ _ _ PERMIT NUMBER one+a.oc HuMSC. F - FINAL OMB No. 2040-0004 I <br />u N /` t e - - - - ~~+.: , i -. ...6n~rn~wfmrelreo.40$~ r96 <br />L_.~-1YJala[:-------- ' `3.V_L~-- B(. 'J 1 . •C 1 1-6Vr-CRV--fViC 'b•o r <br />~~ MONITORING PERIOD <br />FACILRY <br />-~--------------------- YEAR MO DAY YEAR MO DAT. <br /> <br />LOCATION FROM <br />________ __________ ,) ~ ro #~1y NO UISCHAHGE ~ <br />~ {"I'K' <br />~ <br />A I' T N : R. L A NC c". WADE C L N E 11 A N A G E ii lzo-al) ('a-IJ) r~4-~s) Rs-n) (18-19) pall) NOTE: Read inatructbne before wmpleGng this form. ' <br /> (J Cud Only) QUANTITY OR LOADING (4 Cud Only) QUALITY OR CONCENTRATION I <br />' <br />' <br />FRED r <br />yA <br />PARAMETER (46-SJ) (54-6)) (J8-45) (46-SJ) (54-61) N0. <br /> E7C ANALrsLS TY <br />(J1-J7) - <br /> AVERAGE MA%IMUM UNRS MINIMUM AVERAGE MAXIMUM UNRB (676]) 68) (69.70) <br />C50 ~TAfi< 4tlliH ACU SAMPLE ti0#rt#C: +X#O'.,fGN , J <br />'~ :.fA###G #fJr###4 ~ Z3 <br />~ <br />~ <br /> MEASUREMENT ~ O ~- ~~ <br />C E R I O D A P H y l ll <br />A!538 L J ~!aRwr ~°'~'a#o!x lot#o~a6~c <br />; n:,-: lU0 __._ _ ##+~~It~., 4ta?oueF!xK~ Eli- ~ <br />*,~ <br /> <br />FFLUENT GRJS-i VALUE ._ <br />RE~u1REMw~IT ... <br />_.. <br />r _- <br />- <br />. <br />r,:~;, <br />KH Y LUE <br />r''„" <br />CF.HT <br />. <br />-r.• ~ <br />~ <br />I <br />+«?~'~ <br />- <br />CSO ST AT i:E 9byl: ACU SAMPLE <br />S +k####Te #>h#L'## ~ tJ <br />/ O() J i`•###I(f;i #101#4#~1 ~ 23~ _ Q <br />O ~ f <br />~ ~~ <br />I. M [.P N. A L ~. :r MEA <br />UREMENT ~ ) ) <br />PAt/tiC 1 0 u <br />PERMIT ##V#CfEI #ri###a . ~:1:~: 100 #o9LC1#'b 71t#ra#ltfl E <br />H- . <br />~' <br />~ ry:,. <br />~ <br />~- <br />=`'FLUEkT G505S.VALUE REQU1gF~MENi :I:::; wµ YRiUE Cg!7T ~'' .::4%s <br /> SAMPLE _ <br /> MEASUREMENT ~ - <br /> <br /> ~_~,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - <br />~ .. .w -~,. „~ ;'~* _. . <br />,~ ~ <br /> RHQVUiEMENT - • <br />,y' - •:"~4.:"., 'i-F2-:' <br />_, .. <br /> SAMPLE <br /> MEASUREMENT f•' <br /> ' ~ <br /> REQUWp]~7ENT 1 tom' l'?" ' ~ <br />e~" <br /> / .. <br /> SAMPLE <br /> MEASUREMENT _ _ ' <br /> <br />- . <br />~2, <br /> RBQUIRFL/E/PT - <br />J. <br />4 _ <br />' SAMPLE ~ ;* <br /> <br />' MEASUREMENT <br /> PERMIT ~ _ :n ' ..". ,',~;.':, ~,, <br /> <br />'WECIJI~MENT r 1,~ . <br />.' <br />~~''-,~"~ .. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ 1 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY Ex AMINED <br />' TELEPNONE - - ': DATE ' <br /> AND AM FAMILIAR WRH THE INFORMAI <br />IOfJ SUBMfRED HEREW, PND FY.fD <br /> ON MY INOURY OF THOSE INdV10UAL5 IMMEDWTELV RESPONSIBLE FOR - <br /> OBTAMING THE WFORMATION I ~UEVE THE SUBMITTED INFORMATION S <br /> TRUE ACCURATE AND COMPLETE. I AM AWARE TIUT THERE ME <br />FI <br />R <br />G <br />F <br /> UNi PENALTIES FO <br />FALSE IN <br />ORMATION INCLUdNG <br />SGN <br />SUBMnTN <br />THE POByBLLITY of FlNE AND MPRISONMEM. SEE to us.c f toot AND <br />33 US <br />G f 1319 (hn1lub under Nr3e uelula mey include (Illei u <br />!O <br />SIGNATURE OF PRINCIPAL, EXECUTIVE <br />- <br /> <br />T . <br />p <br />BD <br />n <br />6 <br />S <br />ICER <br />UTHO <br />ED AG <br />T AREA <br />' <br />TYPED OR PRIN <br />ED and or ma <br />mum unpruonmenl of benvsn <br />rtromni vld <br />yurs) <br />f IBD OFF <br />RIZ <br />OR A <br />EN NUMBER YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Re(erened sll iffechmenl6 here) <br />ACUTE 'AET. LIHITt. BECJ7F. EFFECTI'I-e 10-:-97: SE?. ..`-+. 3, F'~ ViI., ''OH DE'!'AILS OF TE_T P30CEDUR:. RF.POHT <br />LC50 - ;TATI~TICAL 'POIN.T f.STIItATb' aI'ICr IS LFT3A1, TL) 5ps OF PEE'; Ok:3AtiI5t!:,, RlID ATTACH ACUTE-TOXICITY <br />orln - 1 ev. - ) arev/ B~Gats may l6BQ ~ IR PLACES ~ PA PORM T-10 MIC MAY NOT BE U$ D.1 ~ n ~ ~I 7 / 7 ~ ~) I, 7 - I I i `) pA~ OP <br />-- 1 <br />