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PERMITTEE NAME/ADDRESS (Include
<br />F~clllty Name Lx.PB/ploon 1! dl7eren(I '
<br />NAME - ~~lY•, !J ~~L~LCt ~ C OJe-Qg A.D~-L L..)-S - - -
<br />ADDRPbb~i~ F:O-H~.nN ;'I~1~-----------
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<br />FACILT'
<br />-----------------------
<br />LOCATgN _______ ______ _ _
<br />AT'_N: R. LAVCE 'JADE, f?iNE "TANAGER
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION BYBTEM (NPOFS)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />(1-16) (17-19)
<br />~0000!'~13 OJ7 A
<br />PERMIT NUMBER oucHwwca wuMSaw
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM - 70
<br />(1411) (11-1J) (N-2f) (16-17) (18-19) (JO-31)
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<br />F - FINAL OMB No. 2040-0004
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<br /> (J GN Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION
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<br />PARAMETER (46-SJ) (54.61) (J8-45) (46-SJ) (51.61) '
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<br />ANALYSE
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<br />(f167) 69-1p)
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<br />~'FFLUENT GkUSS VALUE ~°u~p6°'R ~ :x;r=°` RTR AYG 30DRr'. AVG ...,D %'111E 9G/L ,
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<br />(A S F ) MEASUREMENT , ~ O
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<br />MEASUREMENT / .. ~~
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<br />FLUM, IN CnNDUIT i)R SAMPLE
<br />MEASUREMENT ?z /. So ( ~J) C: ,x ^': ':;: #+t>adrt rr #opa+Ad _ 1
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<br />ULIDS, '"UTAL SAMPLE #4Y1 rA V:` ax (4 r~14 i11¢ alxlx :A {:'.: ~ lf~) f/.
<br />I S S UL V E D MEASUREMENT 193 3t~ /~40. Gi4a-F3
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<br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I cERDFY UNDER PENALTY OP LAw THAT I HAVE PERSONAUV ExwMINED - TELEPHONE - - "- D A T E
<br /> AND AM FAMEMR WITH THE INFORMATION SUBMITTED HEREW: AND °. crD _
<br /> dV MY INOIJRY CF TIOSE WDVIXIALS IMMEOMTELY RESPONSIBLE FOR ~ ~ '.
<br /> O@rAWING THE INFORMP.TgN I ffLIEVE THE SUBAYTTED WFORMAIION I$ '
<br /> TRUE ACCURATE AND CpaPLETE I AM AWARE THAT THERE ARE
<br /> SGNIFKNfT PENALTES FOR SUaMfTTWG FALSE INFORMATION INCLUDNG
<br />THE POSSIBO-TTY OF FWE AND MPRLSDNMEIJr SEE IS USG f IoD1 AND
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />33 US.C 1 1319. (Prn,N
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<br />tlpD6p aM or maximum unpnaoemenl W between 6 mm~lha and S years) OFFICER OR AUTHORIZED AGENT NUMBER= YEAR MO DAY
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all afnchmenfs here)
<br />T55 t: Ft LI+fITS JJ:LL EE 4AIYED :: S::T.TLF:ARLF 5`)LIC:: LZ7I'C APPLIED FUfZ C=l0YN,24HR PRECIP EVENT ONLY YREN
<br />RUM1f)FF CUNSTI';U'f~5 MAJORITY OF LI)AD-Sf.E I.A.1(D), 1t; v, E'1:1k ?i;Vl!ZRE!1ElITS. DETECTION LIttITS-SEE I. F. 2.
<br />32 v. - loos fG~orls may- I6 /REP ACES EPA M t-40 W GH MA NOT BE SED.1• ~ _ pgpg Op
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