|
PewMlrTCC NAMClwooweaa (Include
<br />Faility Name/Lonrbn if diffarnr/. .
<br />NAM^_CYk n!., Yes'u_5 d::LLtY D~Ai. C.i t,6. __
<br />woo~EEEN175c 1,25 Ui~_"tl, ~ L5_::.'(+N Yf:--
<br />___91Ui iA:iT ~,IA~I:RL .:tisCL:' _ __
<br />___~uGL,..NUUL' __,___ CC JL155
<br />-wuurv --- -----
<br />LOCATIOM _---------~--~----
<br />e~P;l,: l~D.'T d. =.L. 6,- ;L ~C:r !•S_i.--
<br />NwnoN wL rouurw NT onEN •weE EuNlwwnoN sYSreM /NPDES,
<br />DISGNgRGE MONITORING REPORT /DMRI
<br />1-/6 1~
<br />,~1/S.JL71~lT (,iJ
<br />PERMIT NUM wCw Nw RCE nVMwaw
<br />MONITORING PERIOD
<br />YEAR MO DAY VEAR MO DAY
<br />FROM ~.. vc ,•A TO ~v .. ,: ~. ~+
<br />Hoag rzz zir (ze.zsr ae nl /za z9) ria //
<br />+~ ~' f Form Approved.
<br />1 ~~ ~ ~ ~ is ~' " ~ OMB(No. 2040-0004.
<br />T' - f : lr ,. i Approval expires 6-30-91.
<br />NOTE: Rand instruetiona bef re co~r5pletinp thin form.
<br /> (3 Cord Only) QUANTITY OR LOADING (1 Card Only) OU ALITY OR CONCENTRATION FREOU ENCr
<br />SAMPLE
<br />PARAMETER (46-33) (J4fil) (38aJ) (16.f3) (J4b/) NO.
<br />X of TYPE
<br />(37-37) E wNwL rsls
<br /> AVERAGE MAXIMUM UNITE MINIMUM AVERAGE MA%IM UM UNIT9 67fiJ) (646N) (o9-]U)
<br />r ~( 6AM PLE yz;::;. ..t 'r{: .r r+•i~~c¢ /
<br />\ ) r ~A'I'Y ~• ( -~.i)
<br /> MEABUREMENT
<br />./U(ll tl 1 ., L :°,
<br />'«y
<br />'' Ss ik;
<br />°rS r"1i ~~»"~2- ?.}:; fj•e
<br />~:ts;b ''~<°.,; ~AYFF'~.:l.x'ry.
<br />° ?dxJ ~Q<'R•.l%
<br />a
<br />' ss~~~:~i °a e°
<br />'~S~"'Lt
<br />rF
<br />'1'
<br />L fiRMt
<br />T
<br />sftEgUiRBM ~N.7
<br />' ,
<br />x
<br />`
<br />: ~% ,
<br />~
<br />"$
<br />R~
<br />id
<br />'g ,l
<br />=
<br />'
<br />~ a
<br />t e
<br />l~
<br />fi
<br />'
<br />~
<br />~°(
<br />;
<br />~ U , .
<br />z
<br />•"
<br />°
<br />LUth:
<br />(~t055 tiA
<br />UF. 1 a
<br />a
<br />~ ;L
<br />.
<br />4,T
<br />~
<br />±
<br />, :
<br />~ ,.°
<br />,
<br />1°
<br />t
<br />r
<br />,
<br />. ~ .
<br />,
<br />~
<br />~OLIDs
<br />.,i1TLEF
<br />_LE lx~X:
<br />X~tll. .v~aa~: ~
<br />( #;~s.tllP: ( LS)
<br />,
<br />. SAMPLE
<br /> MEABUREMENT
<br />.v545 i L U .,_. " ~{a ."r"rt;..naKeeC
<br />° ### :x},Lr~ a~a
<br />> °n>{i~rClJi. °` ~~'
<br />i'~~~
<br />,~
<br />a ~i~.~>°
<br />~ tisa~rs.°
<br />-
<br />'
<br />' "R~'OUIREMENT p
<br />~" K:#~
<br /># x ~
<br />'
<br />`'
<br />°
<br />'
<br />'
<br />#~ ,
<br />a
<br />'
<br />°
<br />~ F` .,
<br />~'
<br />'
<br />t :
<br />`
<br />DEL l
<br />GI
<br />.IiL.~TS n
<br />:.L(:, ~ - r
<br />R ~t
<br />]t
<br />~s
<br /><
<br />;I
<br /><
<br />' °
<br />~4,
<br />Y."~iPs
<br />IY tfL/L •~
<br />.~
<br />~
<br />~li :
<br />,\•
<br />a L
<br />TTLk:nl)T'
<br />~QL1I~J ;+:~:/'~::~ :')U-r
<br />## ~ ~ -/Y~~.-r ••~ ~ ZJ~
<br />, .
<br />. SAMPLE
<br /> MEABUREMENT
<br />. v fi5 .] 1 .' ° °~
<br />'PERMI'T' .~ ~$k ~T :} x'Yr'[ v4`f°° I}~:: a4+f2 iXe;15 a%~'
<br />'
<br />~
<br />` ~5
<br />°::}°~i~~ ~
<br />' °~ ° ° °,;.•;
<br />e y, .
<br />,° •..• .~ t
<br />~°~'./.a
<br />f3s^..•
<br />~`
<br />.~.
<br />`
<br />v
<br />Fi•'
<br />G
<br />iS
<br />•
<br />J
<br />i
<br />A A80UIkEM EN?. ' 'a
<br />" =n'-
<br />~:;f <
<br />.
<br />~..
<br />esxx•
<br />"x
<br />,r
<br />.e
<br />° ,
<br />;
<br />.
<br />'
<br />'I
<br />,
<br />'
<br />'
<br />"
<br />~
<br />, 4
<br />ta5p
<br />'a
<br />`ll
<br />i
<br />S
<br />°'
<br />~` '
<br />L 'r"~ ;
<br />x e°•`
<br />:
<br />i, _
<br />.
<br />~~.
<br />Y
<br />L
<br />t °
<br />9 >
<br />4
<br />~ •. ,
<br />g~ ar,
<br />,
<br />. ~
<br />w
<br />~f
<br />t„
<br />i
<br />c
<br />~
<br />~l
<br />" ~4
<br />;1~.
<br />,~
<br />1,
<br />#
<br />. (
<br />i
<br />/r_ ~
<br />~.~
<br />JIL 1i lVU .z 11 '
<br />~.i~ .
<br />•~'v iF 4 3r Jli zr +i4 ( ' ###+}#G ~XI%. ~ . . (
<br />t~
<br />. SAMPLE y
<br />dcC%:i LXLC-G ~P.V y! 1(1 MEA6UREMENT
<br />~JSSo ~ Q U epMl `.
<br />°° a -;r:;;a+~'s. .x!~~r:a~';u ~lav °'"~xx sorb;,. :~~,°
<br />~ +p rt}`,.'_; °a`"~., N
<br />L%?}'ti 1i~~"'°
<br />
<br />'
<br />' '
<br />dE UIREM~NT' -
<br />~•
<br />+ ~
<br />~
<br />(
<br />~
<br />'
<br />C .
<br />~
<br />'
<br />~ "
<br />)D
<br />FLUo:i .;f10~5 YAL
<br />:,M , v z,
<br />° ) .a;
<br />+, «~i
<br />;
<br />k
<br />~,%id(;
<br />,'` :! _ ~
<br />1F
<br />Ll:h
<br />1 LC ~tLUIi ~z
<br />1
<br />T { l3~ rXI %.=v%,'~. ####i'fiY ~v + (
<br />,
<br />.
<br />• 6AMPLE
<br />HtU I}I t.wl ti°hi E'LA:~T MEABUREMENT
<br />OUSI/ 2 U 0 r~°;'r`eRi('tr'"°
<br />t .°+)`kts`tJ}?!Y°;as. _ ~,'P•I~!~;4C"x<' ;~4~ara;ee= ~~~ . ''4~t:~e:~Y~;~ ac=x ~ ,
<br />d~°g ;~~~SiL.~: •~~~.,~~,~
<br />OSS VALUE
<br />'
<br />- RfigUiREM 6N'f j~
<br />.
<br />~~~'k~~„ °.'~"A-~
<br />i
<br />~
<br />~~ nG ` `> ', s, #;~ _'`
<br />"
<br />PFLUEt,
<br />GR
<br />- ,
<br />~~.~ ,~
<br />~
<br />,
<br />~ °
<br />,
<br />~<
<br />° D ...'
<br />=~. ` ,
<br />JLL AtiL
<br />~kEASE a#><zs:;< ( g4) #rs:a## a;;.,:x;. X:va;~.p5x ( )
<br /> SAMPLE
<br />L S D A L M EA6UR EM ENT
<br />
<br />b+lOt,b 1 I. C
<br />`e `PERMIT'x
<br />.„(~"S:{t°rv~E{`<
<br />}«ja <°+~ae'~
<br />:..y=l
<br />•`«~r° ^ ~~€«
<br />'h°~I '4k-
<br />,"
<br />1Te~'R "~:x
<br />#rX. g
<br />~~:~yP~
<br />~a~j'~,~.°
<br />" w8G41REM ENT >~
<br />'
<br />.
<br />' s "
<br />FFLUEt'T ui,OJS 4e f.Lli~ ~
<br />°~,
<br />~a~<
<br />,~a ,40=L
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ' ^PERM ITx ':., ~y
<br />' ee" 'xe` a"
<br />% a°" m~'
<br />i °e
<br />~ nA° °.«
<br />p
<br /> ~REQUIRE M BN'Ik l
<br />° °~. .k,'n- ° <
<br />a
<br />,'
<br />^
<br /> ° ° a,
<br />° x, a F ~
<br />tl
<br />p x
<br />g
<br />tl
<br />tl p «
<br />m °
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER CERTIFY UNDER PENALTY of Lww THAT I NAVE
<br />vERSOrvwLlr E%AMINED
<br />I
<br />•Np AM FAMILIAR WITH THE M'FORMA11pN 9UBMITTED HEREIN AND BA6EO ' TELEPHONE D
<br />A T
<br />E
<br />
<br />ti~ills
<br />Rlcharu ON MY INOUIRr OF THOSE INdVIWALS IMNEpATELr R[SPONSIBLC fOR
<br />OBTAINING THE MFORMATION. I BELIEVE TNC SUBWTTED ,NFORMATION /
<br />/ ~' ~ -
<br />~
<br />~
<br />.
<br />t
<br />l
<br />'
<br />^ IS TRUC dCCURATE FNO COMPLETE , wM AWIRE iNAT TMCRE LRC SK.
<br />NRICANT PENALTIES FOR 9,1BNITTING FALSE INFORMATION ,ryCLUdNG ~
<br />/
<br />~ ~ /(~~I ~5~l
<br />(9701810-L7~2 -f
<br />I +~C
<br /><V ,
<br />f
<br />aiage,
<br />a
<br />,
<br />On
<br />Enviro~r
<br />IMPR
<br />P
<br />I
<br />T
<br />F FINE
<br />SON
<br />Ni SEE
<br />5C 5
<br />1 A
<br />O .
<br /> BILI
<br />r O
<br />I
<br />,00
<br />THE
<br />OSS
<br />AnD
<br />M[
<br />IB u
<br />N
<br />33 V SC 5 , 319 /Prnalnr~ u/drr ICrY Zululr. n,ar ,nrldr )~nr. uY Y, jll/IXYI SIGNATURE OF PRINCIPAL E%EC UTIVE
<br />TYPED OR PRINTED n/d... mar~mom/mpr/s.,./mm.u .4 Mluv+n Em,.nrA+vnd.; ,ear,/ OFFICER OR AUTHORIZED AGENT A EA NVMBER YEAR MO DAY
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Kr/rrrnrr ull Yuuon111m1z weer)
<br />y 1 1 r T
<br />bL ~1Lt1: :. .._ SOLI. is=~ }. ~. ~., wniV~u (..uC Y ~ ,.nx.Y i[ iL-Yn, C51- I,i I ...~iL-~ ;. J:. i LS _LA.. ..: L. ;i~E L.A. i,
<br />:c: _tl, FU.~ ll; 4ilc' 'it rii.; s:F kf ~i iil nLM.a1T:. :.LL :;.•in.°i c-..c fUOll. liis F/, r.• ~. ,:,} LY ~; L: ..i _r i, ,
<br />EPA Form 3320.1(Rav. fFlB)P/6vtoua BdiBona maybe used. IwEPLACEa EPA FOwM r-AO wHICN Mwr nor ac uacD.I r _ PwcE of
<br />LIl.DE./i,..~ ,. ~ .. ,
<br />
|