|
PERMITTEC NAME/AODR[le (fnClud[
<br />F~eRlry NEYne/Lo[atbn lJdiJfnent)
<br />NAME_'_r `______________
<br />woloREn 1 Iv ,.;, i , . ~ _ . .
<br />~' T - _
<br />--a-. l~v _A ~ _-===--------
<br />___~4LE{iOGL ______ ~ ______
<br />-w_iurr_____ _______ - ..___
<br />LOCATION __ --_
<br />. Il• IIA1F ,I.
<br />N ATIONIIL FOLLU TIINT OIEENIIRGE [LIM INATION fYSTEM (NPDESI
<br />D 19CNARGE MONITORING REPORT /DMRI
<br />7-16 (7-/9
<br />~.. :. ~ '4 LIB
<br />PERMIT NUM DER RncNwwcE nor•u
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM • I ~ ., i TO ~ - . ~ _ y '
<br />/JO.JN /IJJL ndAU na_on na.vm :m
<br />Form Approved.
<br />•' •' ") OMB`No.2040-0004.
<br />- ~ ~ .~ _ ~ Approval expires 630-91.
<br />NOTFe Rwri inatrucfinna hd..... mwl.Knw ehi• for T.
<br /> (! Ca.d Only) QUANTITY OR LOADING (1 Card Onty) QUALITY OR CONCENTRATION
<br />PARAMETER (16-J!) (Jlfil) (lB~J
<br />) (16.13) (J16!)
<br />NO. FR EOU ENCr
<br />DF
<br />9AMPLE
<br />TYPE
<br />(J7-37) E% AN ALYSIs
<br /> AVERAGE MA%IMUM UNITE MINIMUM AVERAGE MA%IMUM UNITS 9
<br />7U
<br /> 616-0 (61fi8) -
<br />)
<br />(6
<br />. -.V.
<br />UYi~-L :,, Y: v..,::,:: \. ;J :r: l.':. :t {: ::::
<br />.
<br />.
<br />~
<br />, BAMPLE ( ) ,
<br />.
<br />. ( ~.•J
<br />(~ ~ F ~ } MEABUREM EHT
<br />
<br />- 3 - (, J
<br />e&PERMI:ra o
<br />' 33~~
<br />
<br />x
<br />g'~g.a:S~IP T~
<br />a !
<br />e~nq~~RA~..,°.>
<br />+f i-i•: .R
<br />Qa •~bYR ~,~'~ET~~ffimn W
<br />Y~ iry.>me °
<br />~ ° { }
<br />itr\D 8e.n ma
<br />e
<br />d
<br />a
<br />6~. ~ ° p
<br />°~
<br />~
<br />
<br />:LJ`,: V/;LJF:
<br />u ,71E U;I
<br />ae~lEnT•
<br />q °
<br />w
<br />;S
<br />~~~ea~ <s`
<br />° .a
<br />. °~a
<br />~...`
<br />~>'
<br />
<br />,r..
<br />:
<br />:
<br />,- ayn'«&'a~a mg
<br />~
<br />•
<br />' p
<br />j~.a~ tt"«`
<br />~~
<br />'
<br />~
<br />' @
<br />.;
<br />.@~ @~~°
<br />.
<br />i~..tt
<br />-i ~ °®a ~g
<br />{a, ~
<br />~'
<br />' 3Ea
<br />''°
<br />~
<br />
<br />J ,
<br />~ .
<br />r
<br />es
<br />b se s',
<br />~
<br />v
<br />• ~.
<br />,° g
<br />g ts
<br />~
<br />xa'„',y
<br />m'rL° a
<br />'
<br />me~,. -F 4'w ~+i, ./ 1.
<br />~ . :
<br />.'a
<br />'n sg. ~,'( `E.
<br />« :~
<br />t
<br />.
<br />, .~ ... ~:. e~ L'. v}' ~
<br />L
<br />3 +,~axl %: Y7k V:}rx'a :: ~~%JJ:}:J ~F
<br /> 6AMPLE
<br />. \ )
<br />•..L ._,.,' + i(,F ITT MEASUREMENT
<br />J .: ~ N
<br />
<br />.. - ' e ¢ e e ,
<br />
<br />a' . •P~RN~1T a tC I.yRe~ t!
<br />
<br />a Ak ~'
<br />"
<br />tl ~
<br />~ ~. Ia+T Jw
<br />~~ 1 &1'~ :'1~ . e
<br />
<br />~ "., a
<br />~e ~ 1~'
<br />'/<~--A'lA v,8
<br />e , » - .
<br />~ ~Ykri` pw`~o ~ P .~ A '^
<br />. n,g@~`~'''Y~ci. Ye Ff,'¢
<br />• m e
<br />'
<br />
<br />°
<br />~~eA'R
<br />
<br />~
<br />.Ra
<br />• rt ~S
<br />_
<br />~~LV
<br />L
<br />~ •REO IR
<br />~., EM:BN~ i
<br />@ s
<br />(
<br />~y,an ,1 _q~qA~
<br />qA~
<br />s
<br />s
<br />+e
<br />A w
<br />q~ ~
<br />s
<br />@a
<br />~
<br />+ ~
<br />`2 T3~f .e'
<br />' <
<br />6m n °
<br />.« @~sa ~a «
<br />®4
<br />y
<br />as @
<br />An ®4 _n
<br />a .
<br />ir ~
<br />~ l
<br />i
<br />8~@
<br />`
<br />i - :.l
<br />.. `Ra:
<br />tl +
<br />1+yk
<br />T
<br />:I.TF
<br />r
<br />~~
<br />fi "
<br />~$
<br />~
<br />V'
<br />~ ~~e ,a a,:
<br />8dw0n¢g 8a
<br />~ne~$6~.3aw A(
<br />e
<br />a ae k ..~®
<br />e ®
<br />ec
<br />in.z
<br />.~
<br />~L Ali •. r v
<br />l
<br />:
<br />:-CJV' ( . ~..
<br />v ~): . /
<br /> BAMPLE +) . . .
<br />. 1 )
<br />,j _ MEA6UREM ENT
<br />(
<br />.>-f .l . Y
<br />15 `'P,E'~N417T'e«
<br />3f 6L(A'Wi ~+F.V~ «
<br />9.Q~"~~g®~~
<br />-Y+«'ai
<br />L~.-L q
<br />~'.F~~aoT~~.Y`5-0' .~~p
<br />®~H{.''I"+6'~iE~YS
<br />g.F~mti $3 '~$d•c '#~
<br />pP'aS y.'~
<br />#'aa:g `s
<br />J
<br />h'i
<br />~f'Q
<br />i
<br />F `REQUIRE~N~, °sf «na ~'a, s
<br />a
<br />s
<br />~
<br />'
<br />~
<br />I
<br />~ $
<br />~a
<br />~s~
<br />r
<br />s
<br />~' ~s
<br />^«
<br />~
<br />~
<br />s s
<br />$
<br />~~ ~ "
<br />:.
<br />.
<br />_ .
<br />C
<br />R4 .S er .,°°
<br />°Y«nc ~@i~2
<br />+
<br />~1f.l
<br />~
<br />R
<br />s AQ=~ ~
<br />°
<br />®'m
<br />a
<br />e, 'a
<br />a
<br />!~
<br />•~f`-:
<br />~
<br />g< ~,o- a'.
<br />a,
<br />° <~ ~aaw ASm
<br /> I{
<br />~
<br /> BAMPLE
<br />'1 4
<br /> MEASUREMENT
<br /> °p'PER4i'I~faa
<br />8
<br />~ !
<br />;+
<br />ssf ~Y xxg~s~:a'
<br />a
<br />'
<br />' "p~.a,een >'aP&a~ 'eQ.a;n@
<br />.°>y'~a en `®~p ~®,a we e~.:
<br />a
<br />'
<br />~ m¢e'In veq
<br />w
<br />'
<br />~ an °~
<br />w ~~~e.,
<br />45
<br />_ R
<br />@OIREMEN~ p
<br />R
<br />yy f846a
<br />b
<br />ff 4°-«'•°R
<br />+
<br />~
<br />t' ~°ee@4 ~? ~
<br />~ a /
<br />s sa
<br />a°T«wea4°~~«
<br />~ '~84
<br />8
<br />&$x '8®.
<br />@ Y~
<br />0.°
<br />g
<br />`®®«g<e nBn Yy 4an ~~
<br />~
<br />'
<br /> se, ~8 k
<br />dn°°e
<br />' +~ ae
<br />i«eL .
<br />a~ i6w ak. - Y6e w:a®n 'a. a®n °Y ~
<br />me3m
<br /> BAMPLE
<br /> MEASUREMENT
<br /> .a'~p~RMjT a'° 3se e@'e
<br />~`3 ~a
<br />a@a¢~'s"
<br />a
<br />~ ma.wo @.., s
<br />
<br />'°m A
<br />~ .... vA
<br />x
<br />'+ s n w x a ~. e
<br />e a n o- e' n
<br />.~
<br />a a.
<br />
<br />° Ewa,
<br />
<br />.
<br />• a a
<br />
<br />mR813DIREM..BN'Tn ~a a
<br />axs ~
<br />a' ~
<br />sb
<br />n
<br />a'Y g.
<br />f@
<br />~
<br />'
<br />`
<br />,
<br />ewae~a a
<br />b$~°'
<br />~~.>
<br />ws~~¢a
<br />'
<br />aa¢ ~.
<br />°.®
<br />~..~18f .x ,a
<br />°
<br />
<br />,Tfa.~,
<br />
<br />a3e
<br />a.
<br />
<br />e
<br />@,
<br />,
<br />as r,
<br />
<br />~mns fl anf
<br />f@
<br />
<br />aaa
<br />
<br />f, ~
<br />
<br /> BAMPLE
<br /> MEASUREMENT
<br /> Yms
<br /> ~!}-
<br />`REQLIR¢T'TNT
<br />b
<br />4°esea°'6°s
<br />a6
<br />x°
<br />•
<br />aI$
<br />'
<br />~
<br />$
<br />~~'g
<br />"
<br />_aYYV4®8°
<br />a
<br />~~@'@'@
<br />e
<br />a®
<br /> x Y~ 6
<br />6°
<br />3A° g
<br />@°a
<br /><w
<br />~® 9>3993n
<br />8 w®9 e®
<br />~ ~.e ° e
<br /> 4x 6a ~m
<br />n b
<br /> 9AMPLE
<br /> MEASUREMENT
<br /> l
<br />R
<br />~ nega
<br />¢n.®baaq ma„~ e~e. 9
<br />ea~eg ~f~3a~ fax
<br />a ~0
<br />a c ex., .,,. ease'
<br />'
<br /> II ~QI
<br />1
<br />MIEIJ.Y
<br />E $
<br />®® bcn<s,
<br />,a, map
<br />a e,
<br />8fa
<br />a$
<br />a ¢
<br />lw as
<br />se
<br />°$ n@~g are .
<br />s @.n .ma
<br />« d
<br />.
<br />~
<br />a
<br /> s°686w
<br />~ 6R~x a.a a 4x~a 'S R.n.g a,g
<br />~ e4
<br />° .: .p.m
<br />a n~
<br />a.,@`
<br />g
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY u6DER FENALrv OF LAw THAT I
<br />NAV[ PERRONALLY E%AMINEO TELEPHONE D
<br />A T E
<br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND M6ED ~
<br />
<br />~L.l)a 1. _I '
<br />'ll.j ON YY INQUIRY OF Trq.E INDVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OfiTMNINO THE MFORMATgM I BELICVE THE sUBMITEO INFORMATION / J /~ r
<br />/
<br />/ ~
<br />//
<br />I
<br />lJ 1 IS TRUE. ACCURITE AND COMPLETE I AM AWIRE THAT TNERC AR[ 510 ,.!/
<br />/
<br />:
<br />/
<br />/
<br />/
<br />1 _
<br />_; ~vl
<br />T
<br />4
<br />rt NIFq„N* PENILTIE$ FOR $UBnITTING FALSE INFORMATON INCLUDING A ~ `
<br />/I
<br />/C
<br />~
<br />ronr
<br />,~~
<br />~
<br />~~-,}
<br />~l
<br />TN[ pD55161LITY OF FINE AND IMPRI$ONNENT $EC Ifi USC 11CO1 AND //~ )/~
<br />J/1• y
<br />J1 V~~/~~
<br />I, 'I
<br />y
<br />C~
<br />' 33 USC 11319 rPmp/n.. uMv. rArv u
<br />mN+ m
<br />l
<br />d 61GN ATU RE OF PRINCIPAL E%ECUTIVE \ _ /-
<br />TYPED OR PRINTED a
<br />mr
<br />u
<br />n /.n.. uy m llu Nw
<br />nod... mannlum mlPrw+~m.ul../A.rvnvnFmunrA. antl ;.w..r OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY
<br />.-~.lJ ... _.• _ .._ cw • Ma.l ~ -. E lJ~ _ -. 1' •.-t.L Ill _ •_ • ... b ~ I ..... ... _ .. _ ~. .. / / r ..•
<br />I`
<br />EPA Form 3520.1 (qw. 9-Da) P/1vFODE BdFfiorie maybe used. ' ' - iRE:LiLCei E.A FoRU Tre wNICN Mwr Ror EE weD.) FweE of
<br />
|