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P[RMITTFE NAME/wDDREf! (InCIYdE <br />Facelry NamalLoca/bn ifQlJfnenl/ <br />NAM[-=' --! -----_- - <br />~_-_.~LbM00D -------= -- <br />IACILIT1f__-_-_----- _----_ <br />LOCATION _ <br />--+ 1. r, ul. A • Yi M i. ---- -(--L.: -- <br />N IITION/1L FO LLUTIINT OH[H ARGE ELIMINATION fYlTCM /NPDESJ <br />D ISCNARGE MONITORING REPORT /DMRI <br />1 /6 17-/9 <br />,.,....7111. ~I <br />PERMIT NUMBER RncwwwuE nUMevw <br />MONITORING PERIOD <br />YEAR MO pAY YEAR MO PAV <br />FROM ~ I .r. ~~ TO J I . • -, .: <br />nn.9/I /n.7 r1 n1.7v zTe. 771 na-Tm Ixnx/I <br />- Form Approved. <br />1 ~ ~ ;~ • '~ ~ 3 oMB`No.4o40-oooa. <br />• - I ..• ^ :. Approval expires 6-30-91. <br />. .. C I L -, .~ ~. - J f l i_ t _ <br />NOTE: Rewd inleruetionE Mfnre enmpletine thif form. <br /> (J Curd Only) QUANTITY OR LOADING (! Card Only) QUALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(16-JJ) (J16I <br />16 <br />(JA~J <br />73) <br />J1~1 <br />NO Fa EOU ENCr <br />6AM PLE <br /> ) ) ( <br />, <br />( <br />) . of TYPE <br />(31-J7) EX ANALr51s <br /> AVERAGE MAXIMUM UNITE MINIMUM AVERAGE MA%IM UM UNIT9 6I6A (616X) leg-JO) <br />... I .V •fLL 6AMPLE '-..,- ri:J:. ~. ( ) v.. ~ l/ <br />(„ ~ F .~) MEABU REM ENT <br />1. .. 1 U U <br />' « .~. ,gn <br />yh M~E?a <br />g aaa;~. ~~r'>~dg.s<. <br /> <br />s °~fvmt'.' 9~",r <br />~J3` <br />, if _~i: ., JJ '~-'Y~, &• ~ <br />., a .a, ~0 <br />~ p {„fig' ..a ~, <br />+kE ~a a, a emme ^¢ <br />~ti,~., e.,, <br />~ <br />~ a <br />°8; •sa<' ~~ <br />RY..~ e <br />~1~~an <br />'_ _ ,FiIJ;~ 6'ALUi ~`REMEM'(a <br />;R Ir <br />>s> e <br />> <br />;;';mT.v,»o~l~a:e.g: ,.i.:.,: ma'~ <br />g a~ <br />a a;iii.Yl4od~f"I~.~a ~;;;y'a~e; <br />y5{ <br />,°~CBJ~ ~e .f~Y8}y g> <br />Iva a ._. ~(. ~i t~IJ ~ Vl( L SAMPLE ( G3) {S.j xS y:vr ;%i~:k ;21} r}4TFr.t4 ( ) <br />i I ; ~ _ Y : _. L ~ •( It. MEABU REM ENT <br />. ~ ~.. i <br />. - w _ . ., ° , el <br />¢ `°I+ERMIT~:% <br />x e n s~<Kn~ <br />,°.~" <br />n <br />`~ , <br />~"~•,ar8~1',.~~ge e ".A~'7A``Y.~y, Y~.rc ~< <br />>"n ® <br />' °"Iyl R4. d"'!6'e' e <br />% <br />a'° <br />' <br />e . ~ `+lm$ ° • <br />'a <br />' v 1.= ... <br />nos a Vx <br />°.,sw~, ~ y C. <br />`,c~';.&s <br />~ <br />i~ I f I ~ <br />i~' <br />L .R <br />liLtaWM 6N'K~ <br />~ z <br />. <br />± s a ¢ <br />° s @rs <br />( <br />~ ¢ ,i <br />' <br />~ <br />~ <br />" <br />° .. c s-a n <br />s <br />. <br />'a«°, e „ <br />dam <br />a <br />~ , <br />.." <br />~, <br />~p,° <br />~¢~`<,x <br />a4 <br />' e <br />, g <br />,."k,a. ~aa< <br />&~'ti <br />Y n,'xe <br /> <br />" .® <br />g 's e ° <br />°o-s <br />. <br />. <br />r <br />~. <br />L .~xa <br />o,- .° v"a; <br />~~t4~a#~ <br />C`..3 a xt <br />~ <br />~~ <br />t~.a' <br />as ~..,L s <br />~ <br />s a:.'g _° <br />°:~..'. „ <br />a. <br />~ <br />_ga gga ~ .gym ~ <br />Ong .%- <br />¢', :;::. s <br />a, el <br />„g <br />„~: a, <br />..j~ <br />... nb~ iJ{:;:0-., ( yµ ;: r <br />: S~'r is , <br />, `:}:: i:.°-.;:: <br />:: <br /> <br />SAMPLE ) , <br />. . <br />. , ( ) <br /> MEABUREMEHT <br /> <br />s _ :, '~ r ,. <br />e ° `'PLtRNIT a <" <br />.°;Id;N"3` 3t9}«rC¢ e~` s <br />1."•r».x n -z s:r^;.«.,} <br />i .J = . <br />'x a Sj p~AY; m ~'R a , <br />~ m 4,w <br />..i a".~~ n n <br />g a ~S .w .. ~.@}x ai <br />- <br />s <br />^ <br />' (y ' t« <br />~ ~^ <br />" <br /> <br />)~hl (! <br />": <br />L <br />r <br />L'J>; <br />RfQDIR" <br />fillT, <br />M <br />e`,g`Ae <br />~6 <br />§ <br />~~1 <br />' <br />-~ <br />~~ <br />_ <br />°°~°e»aA~¢» a <br />sa <br />%a <br />® <br />aa <br />nt <br />, <br />~e p <br />~ <br />~a a <br />b <br />- . <br />, <br />. <br />I. <br />+ w'" <br />a sia, <br />° ~ <br />~• <br />s <br />~'. <br />.¢a a ~ <br />a <br />se; 3.~f <br />®ee« °a `o~. a° ern <br /> SAMPLE <br /> MEASUREMENT <br /> <br />.r <br />/°'g.P,C[~MfT.a ee 8 <br />!&d 84 Ls.~iYexi ~~e~ <br />x <, . <br />. <br />sa <br />° <br />I,~°se)8¢a¢a <br />~ <br />as <br />~«sTIIY~w se ~~g' <br />v <br />A <br />° <br />'a°a¢.e &~g'svsae <br />Bs s <br />°~ <br />anwy.,aa leas <br />® <br />ar <br />a <br />ab <br />V' m. a <br />~» <br />„~® ase <br />g <br />a <br /> REQ(J1R[MENTS <br />' l <br />z <br />J.q <br />~f°. <br />r~ <br />"a <br />s44 s. <br />sssa. <br />8 g <br />L4 <br />- <br />~ a„q <br />ta <br />a <br />S>a <br />' <br />• <br />~~ Ya e®; <br />%~ <br />P~3 <br />atl ss®ag <br />_ma <br />g q <br />g m <br />a~. n <br />~ <br />, <br /> p4 <br /><x x° g <br />f~ <br />w 48Ya'~ c° <br />q< <br />S <br />IIA ~>x <br />e <br />emM x <br />®Rce 4 <br />`e 5n &a <br />a ($~.gg <br />n ebg t.&m ~~e%'8 <br /> <br /> SAMPLE <br /> M EABU R <br />EM EHT <br /> y <br />a <br />y <br />PU k ~ <br />, <br />~ a, <br />~ ~ s< <br />s <br />° <br />l x <br />g <br />' ° ~a <br /> REp <br />EMEN? n <br />a¢°s $eaa <br />x'»ags s~ ~e®Sa~»~' ~ <br />~ <br />® <br />~ <br />a ISS <br />$ <br />e <br />@~ °% ~~ xas <br />® <br /> , <br />®s <br />wg <br />az a <br />s g <br />~®m a <br />a°x <br />g @ <br />a <br />~ $ . <br />~ ,n <br />r <br /> SAMPLE <br /> MEASUREMENT <br /> 9 <br />~ ° <br />a sc <br />° <br />~ 'v <br />a a«zs~a a® ® gag as <br />, ea sc a~ ~ 1 <br />s <br /> N~6VIR[MENT a <br /><° <br />° <br />aes' <br />~°"0 as. <br />IIa«~nx a <br />a¢ ~z g <br />a <br />~waa <br />'~ <~~®~a »:n .~ <br />° n ,n s® <br />¢g®~ <br />asp<.a°a < <br />sa ~s ~ <br />a ewa,~.. ~ <br />g <br />.s <br />m~'x'e<. <br /> , <br />°Baa g <br />eM~9° Fe< ~ <br />®< <br />.Va° ~egga '®° <aa <br />g~3g°g°' gSe B ~R'~a+° g&. ®9w~w <br /> SAMPLE <br /> MEABUREMEHT <br /> a~ ® <br />" ~ <br /> sREOE~REAfENT$ 3n.i <br />~~q °~ <br />~ aa <br />g~ <br />Q g <br />~sa g@®°.%'~'S <br />g~a4m~ g 35®~° .AaS S <br />ffi <br />> ~ ~~geb <br /> p, <br />g,m ps <br />a <br />a <br />g <br />e ~ <br />v ¢~4a e aa <br />it °~a P a~g <br />. ff <br />aw <br />~ <br />NAME/TITLE PRINCIPAL !X[CUTIVE OFFICER I CCRTIFr UNDER PENALrv OF LAw <br />TNAT I NAVE PER50NALLr EEAMINED TELEPHONE DATE <br /> AND AM FAMILIAP WITH THE INFORMATION SUBMITTED HEREIN. ANO BIISCD \ <br /> ON MY INQUIRY OF THOSE INdVIDUALS IMMCpATCLY RCSPONSIBLE iOR <br />~ <br />l "aka rd ILI~I--. <br />' OBTAINwG THE INFORMRq>I I BELIEVE THE SUBMITTED INFORMATION <br />IS'TRUE ACCURATE AHD COMPLETE I AM AWARE THAT T <br />A /F <br />~///lll / <br />~ <br />~ <br />~ <br /> <br />T <br />P <br />ivfr <br />r <br />- <br />i <br />T <br />t HERE <br />RE SIG <br />NIFIUNT PENALTIES FOa SUBMITTING F4LSE INFORMRIpN IHCLUpHG / ~ <br />Ln'' <br />j/ <br />~ <br />~// pry ! O <br />R7019 <br />C-L7~/ l~ <br />C p <br />7 <br />^ <br />, <br />. <br />. <br />, <br />..anL. <br />r,) <br />~a~~ <br />~ <br />- D <br />THE Pp55101uTr OF FIN[ AND 1MPR50NMENr SEE IB USC f 1001 AND _ / <br />- U l. 1, <br /> <br />33 V S C 1 1 l19 IPrnarfv. u/Idrr Ihrv Iulr" n nrl <br />Na lev I <br />dr / <br />I <br />lII <br />IM SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TTPED OR PRINTED u <br />r. <br />Inr. liy <br />I <br />/I <br />a•d~~r maalniwilnlprl ovlnl.lil•,/M~tu.rnfim..nlA.andi•wr., <br />OFFICER OR AUTHORIZED AGENT <br />A A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />-.~ 1. .41 i.-. ., . •. F .. ..a ra:. ... ..~ .. II: I l..r .,. ~. .. -_. Imo. .. ~ .._.-.__ ,..~ ~- '/ <br />E <br />EPA Foti113320.1 (REV. 1I-8!) Pr[vhu9 etlitiolis maybe used. • " y ~ - ~ `"~jweiLwce! iPw'PORAi ---ao wNIEN Mwr nor BE ufcD.l _ PweE of <br />