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PE RMITTEE NAM EIADDREFS /IREIYdR Fatdity None/LarLrbn If different/ ff/~-_c_I'i-------- ----- ---fi~,J EA5 =1---------- ---.. T:(~LE:M000 ------------ .~..• !wcILITy- __________ LOCATION -_--_-_~ -_---------- C.h:.~ A. li~ , - N ATIONIIL POLLV TA MT OISCNIIRO[ ELIM IN IITION IYSTFM /NYDESI DISCHARGE MONITORING REPORT /OMRI 1 /6 17-/9 ..~...._7_.-/ PERMIT NUM BER OIECNw RCR NISMlEw MONITORING PERIOD YEAR MO DAY YEAR MO DAV FROM ~ ~ ~ ~ TO • -, ~ . 110-1/l 111131 /N-1Jl (16171 11819/ 130.71/ ' "- Form Approved. ~ ~~ ~~ - ~ > ~ 1 OM&No.4040-0004. - . ~ - - L Approval expires 630-91. NOTE: Read inrtruetiona before wmpletiny this form. (J Card Only) QUANTITY OR LOADING (f Card Only) OU ALITY OR CONCENTRATION PARAMETER (16-J3) (Jlfil) (38~J) (1637) (Jlfil) NO' FREOU ENCY OF SAMPLE TYPE (3I-37) E% wNAL rsls AVERAGE MA%IMUM UNITa MINIMUM AVERAGE MA%IM UM UNITS 61 d!) (6138) I69-]B) - 6AMPLE ': y.F'F ~.~ ... .... v ~ ~ .1 ... 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J (+ - - .<> _., e .. ~ < aAERMIT' ~ :g3m~r•a~~fl)%.Y ~ a "i~~a ~ '~A'f'a~ 1•i', ~ ~- sr b_; »~6 L~~~d 'k •».;. d.- .'"Rn s Z+~I~Yv ~ ,a e ~x b ° ~a ~ ~ ° a i1q i1 ~~<~ aa.;a''., , (t1 . . ~ ; ' GFOS , xR6QU)REM*NT` ' e j 9n '9w # 9 dlF r: +. ~ r ., .a ~ & s ` , q ~< a - ~ ` "` x ,u _ d ° A i .. . 1 ~~ ~ r A'.• a~F i.»" f a, s e a: Y • P.." x . IPt ~~E° ~ ~h. ~ a w~ a . M{.~L a ~> ~ ::~a ~i~+. -~ _ .~«EASE SAMPLE 't!- :J .:V+I ~ ~ .'}-aY1J ~ ~ .. ...~ ~M O::::., / i3\ / ,. _ . cwtt-G F.AY ~ MEASUREMENT \ - ,_ ~ ~. ~ G r ,a .."t .e' a ~g~~s9 ~~<T: " . gi; &~a""'+ es,a ~ ...:. s '$ -S.»i °a4 ~ e'~~~+y~a'~iA A ' ' ~ i°S:i> «'`x s x i$; ~ ~ °I' 14A~°~' 1 '1 eREVl71REtA ENT % e ~¢,,~ > ~;; ~, e ° °n a aas , . ~ x »~»a:, °-e° s , , ¢ x% `» . ,a a v.' x . . n i ~', ~, ~,a. "n ~s 1 .: lV M.0$$.. _(. s v •f » ° < as ~ ~, v ~ ,~, . u • • i F cO7?Di1TT - SAMPLE ~ vJ~ 44n :. ~ ::.:.. ,:Q=. ~ / I - ~ TNEkI r( YL MEABUREMEHT __ - •. .,a PE.RMiT'°a. 9 `a ~~~ >~'~.<. °4?'r`~fgY/S$ ~ xt ' L. Q. AFg~ s' •~~~a°aa"«a 6~ Rn N °~~~~-'k`lA~b e . ' 6 ~ ~ac~=A~~. ~`~... S ~ $`( ~ a~x ~ yip' S°fe ~TS'A »m ey~4 WJ y Ct~ :"1 UGa v nLu R80UlItEId HNT ~ , f° $ $ 9 s ~ ¢~ i « q w ¢ °~ ~ ' ~If $~~ A , Q rx't1 ax « , a ~ a g ° e$`° y e as s °t e ~ m a" l $ L .., . W . atd % '.; : ° «a e .°. 3+ J U " g, of a a» ~ x~ ^ e bg . x ;.~~ , -i.. App r.. . it r':I ~ ~ / If~ ...-. %., {f +, :J ~. . o ... / . BAMPLF \ . E J a L,LgL MEABUREMEHT If J t 6 1 .. s-'°,e.PERM'17« ° e ° °'°:%~~LseT;S:S~ e. e~ ni V .'`~ ~«-,.m E °~ [ , _ y ~,~~~~ ~'R° ~ z w"~ a ~>t:R~.~'° ;~e~« a a;~; ¢.,~CJ ~:x .~: a~ e ":. ~m.s, xa,Y<; ): ~~ «« ~. ~ ~ LJ r l:k n i :REPW EMEMT ~" : `s~° ° m a = ;~ a l 9p° ~ ~.. " _ . g, a ., a : ~ ~z: - «;. :°aa g~a "a q a t"«n ag ; s xmt®.r~ Z~n f. g ~+a « ~ _ I. : ~. l . . a® e. xz a , l '°.gt ~ ,~ • ~ Po ~ ap z:q ° > R ~ -~ <e.~xx .~~, a. SAMPLE MEASUREMENT Te°a ¢~'6PERM tll T a °< ptl °f°16 r °e ~, ~ S e s "<eg & > ~®x 9 a n< we . »sa Po 9 ~°a.ga<„ ° a "a x a ~«e .,s e. eq aPo ( t ETlTx RCQUiRE e an o-`# a$ s A 's x 4 az ¢e w e ~ ~ ° ~~ g $ &~ ° g ~ ~~ ~ ~ e ¢ xa s ag ~, ~g n ~3a aq x e $•f.".,n ~ p ~a'-b sam p ° S., ° <~s x ~P~, NAME/TITLE PRINCIPAL !%ECUTIVE OFFICER I CERTIFY unDER PENALTY OF LAw TNwT I NAVE PERSONALLr EawMIN[D TELEPHONE D A T E ANO AM FAMILIAR WITH THE INFORMATION SUBMITTED MERLIN ANO BASED 1 '1 i 1 h d OM MY INQUIRY OF THOSE INpvIGUALS IMMEDIATELI' RESPONSIBLE FC/i OBTAINING THE INFORMATIONI I BELIEVE THE SUBMITTED INFORMATION ~ ~ /~ ' ~ ~ 1. c ~r 1.~"ll S IS TPUE. ACCURATE wND COMPLETE I AM 4WARE THAT THERE ARE SIG / / / ~ - ~/~/ / : G f ' NRICANi PENALTIES FOR SUBMITTING FALSE MIORMATpN INCLUDING / . : , L I (!~-1 1 n 1 'r I.:,vironmentnl , .^ T:J~~'r THE POSSIBILITY Oi FINE ANO IMPRISONMENT 5EE IB USC 11DDI AND . `JlV ~o-7 f 7 1 O L ?` [1p JL1 ]]u5C 11319 Ip do tA lb tl mb l d SIGNATURE OF PRINCIPAL E%ECUTIVE TYPED OR PRINTED .na rlln r. un o . m mr u o /In.. uy m Jln MV. vd...n.anm.m lmP.nlul m.ul.,/b.mwnAml,mA. and .i .oa.v OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO OAY ..... ~..rLwnnl wn v. nLl •wLnll.una L.n~•~w nu u.mulmr..n nom R i 1 'L- • F EPA Form 3320=1(Rev. ¢BB)~Piwlous Mitioris iney be u&Bd. ~ IRVLACEl EPw PORM T-.o WHICH MwY nor aE USeD.I PAGE uF Lam.. ].~_ .-.._