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PERMITTFE NAME/ADDRESS (Inclode
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<br />NAME - ~ E.S.'P` ' - 3.y ~ J °.L ~ SJ~O 4 EDS.-~ I, i.i _ _ _
<br />ADDRESS~(~rM, ~0'~~~~(J~JV}~_~',~J~il F`-_-_____--
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<br />FAOILrTY ___________________
<br />LOGATION ________ _--
<br />ATTNi F.. LANCE' WAD>;, KZ11E MANAGE?:
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<br />- -~ (J Card Only) QUANTITY OR LOADING (4 Ce(d On/y) QUALITY OR C GENTRATgN
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<br />PARAMETER
<br />(46-5J) (SI.6U
<br />(38-45) (46-SJ)
<br />4-6U
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<br />STYPE
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<br /> AVERAGE MA%IMUM UNIT MINIMUM AVERAGE' MK%IMUM UNfTS (eF47) (61-0!) - (6110)
<br />tl SAMPLE ,x OVF :, h:x #{A,C'!t 4:# // ###„#:x. ( 12) ~
<br />
<br />MEASUREMENT
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<br />O o O') 1 ! .. 'PERiMIT ~##F .i`LAt a.-kAl~r#i~ '., :. '. fi.:• #
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<br />'r'FLUENT GRO55 Y;,LU.; "~~"'~'~ c'=~~- ttINlrun _
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<br />;OLIDS, SF'TTLEASLE SAMPLE 4y:xr,r;h rl>~w:x,y,;< ~ ., ( 25) a '.
<br /> MEASUREMENT ~ T,
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<br />OSUS 1 0 .O ;,~, acl#aoa. a±o-aaaa : :x:.:: OPTIONAL AEPO$'l _ ;`
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<br />:FFLUENT GROSS YALU:: ~~!~~'! ~ ~ ~ a-x,x:~ R7R AY6 300 '+: J19 'ltx.
<br />~ NL/L
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<br />IL AND Gk EASE
<br />SAMPLEI
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<br />, MEASUREMENT - ~
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<br />3582 1 0 n', ~„~;,. ' . "~z~ra>Italo aJ~a~+aa- :x:xc:, . ~laa~#aa_ oeacgl :;% ;.
<br />'FFLUENT GROSS `. ALOE I~EnuIR>~nwT)1 :x :( ~•~I. , ''; {IO • : ~X> tlC/L '
<br />LOW, IN CUNDU T OH SAMPLE
<br />, ( 03) ,. .;ay~A,.,, #aal:~x!>,r; aaaaa# - ~_ ,
<br />NRU TREAT'1 :: NT (PLANT MEASUREMENT
<br />~ 1.1~ r.. I
<br />0050 1 0 G ,. '
<br />.'per rT &EPOI}T REPORT t~#### as#o14fn ~BAf. - +A#c:'
<br />'FFLUENT t;RUSS V` UF. ?~u!RpfErrr 380A 1tYG D11ILY nY• "GL )'~+~"". ##aa
<br />-OLiDS, TOTAL \'~'~ SAMPLEI• 4'#C##YA #l':LOCt',a ##{[:x-',[,: ( 1,I) -- rs I ~
<br />ISSOLYt;U MEASUREMENT ~,l. .' ,:v
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<br />0235 1 0 0 ~~,,. r aaaaaa a+a+~r##'n :l,;v aaa#aa RELb&!' :; 0'P I. -
<br />..FFLUENT GROSS VALUE' weQUIRE14ENr, • :x ::~:. BYA AYC.` $ 7l]C rfC/L i ~•
<br />IL AND Gif EASE SAMPLE tU#~S O':. ( yy~ ; r{,yrl f::t:;: K>'fA##C :c ;aaf~~+a l1
<br />1 S U A L MEASUREMENT ~ _
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<br />PERMIT as#rla~a es=1 a~ +~## ~ao'a+lf~
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<br />'FFLUENT G3US5 VALUE R?°Ulgnaer4r IRST 1'AX :0=0
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<br /> MEASUREMENT r~C.
<br /> - PERMIT ~~ ~ ~ n.. ;~/. ,~,v may.:
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER . I CERT,FY UNDER PENAirr aF LAw THAT I HAVE PERSONALLT Ex.)erIIFD '~ ~ ~ TELEPHONE - : D A T E
<br /> AND AM FAMRUR WR}, THE INFORMAT,ON SUBMnTED HEREW: AND ByaED
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<br />INOURT OF THOSE WDVDUALS MMEDMTELY RESPONSI Ofl
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<br /> OHTANWG THE INFORMATICYI I
<br />FEUEVE THE SUBMITTED WFORMA LS ~
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<br /> TRUE ACCLRATE AND COMPLETE I AM AWARE THAT TFIE ARE
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<br />TYPED OR PRINTED ~ IOfN10 u,C a Iwiimum imaruol,ma,(d 6ehvrn 6 rbmthr uW S yvn) OFFICER OR AUTHORIZED AGENT = NUMBER' ~ YEAR IMO DAY
<br />NATIONAL POLLUTANT DIbCNARGE ELIMINATION BYbTEM (NFOL'S)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />(1-I6) (17-19)
<br />~OG00•J~13 006 A
<br />PERMIT NUMBER ol.cwwwc. N~Neiw
<br />MONITORING PERIOD ,. ;\
<br />YEAR MO DAY TEAR MO DAY-
<br />FROM v TO
<br />(IP111 (11-1J) (14-15) (I6-17) (18-19) (JO-JI)
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<br />(S U 8 R W C) ERlPS9P~oved.
<br />F - FINAL OMB No. 2040-0004
<br />POND RUNOFF~9'R~4~~fitPI.3A"sBRAW
<br />~~# NO bISCRARG6 ~~ a'~~':
<br />NOTE: R Instructions before mplefing this farm.
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (RCfeltnte !ll !alChmenn hCre) / ~ -
<br />SETT ABLE SOLIDS LIMIT WILL BE WATVEG F04 >l0YH,21iriR Pii~,CIP EVENT-SEE I. A.1(D). PC Y, FOA REQUIRENENYS•
<br />p$yILY SAtiPLIHG INSTRUCTIOWS-I.C.B, PG~.TI. 30 DAY AYG i; LL)jGHEST MONTHLY AVr, DURING PERIOD REPORTED. '
<br />may
<br />IREPLAGES EPA FORM T-.0 WHICH MAY NOT BE USED.1
<br />~~:: ~f ~OS•lI'.~7_l I.J ~, PAQE ~OF
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