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PERMITTEE NAME/ADDRESS (Include <br />Fari(iq A'ame/C o[alion iC dif(emnt/ <br />NAME__ - - -~-T--?'tom _L ~ ~ e~S1-«-_- <br />ADDRESS~I ~ ~a _) t ~ T V r' _ _ _ _ <br />FACILITY_ _ l_____ ______ <br />NATIONAL POLLUTANT DISCNgRGE ELIMIN gTION SYSTEM I NPDE$1 <br />DISCHARGE MONITORING REPORT r DAIR1 <br />!1-161 117-19) <br /> . _ 3~ r ~r r.O '~ <br />7~1 <br /> PERMIT NUMBER a <br />cc NU.reca <br /> MONITORING PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />FROM TO y <br /> r?0-,ll /?)-JII /JJ-0SA, ~ I'6-?]1 /'R-?91 L:0-ill <br />n n ~ ~, o ~ Form Approved. ? ? ~ .l '~ <br />}' _ p T .~ ~ . OMB No. 2040-0004 <br />~• ? ~~ ~ ,~ Approval expires 10-31-94 <br />NOTE: Read instructions before•.G000iim~'pleting this form. <br /> (i CaFd Only) QUANTITY OR LOADING (.t Card Onl1') QUALITY OR CONCENTRATION <br />PARAMETER (~ti-J 7) (54-61) f7R-i5) (a6-S7) (J9-611 NO, FREQUENCY <br />OF SAMPLE <br /> EX PNALV SlS TYPE <br />(izpJ1 <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS IfialJl <br />(Pf 6dJ !69 JOr <br />"! <br />.. -. <br />.. •.:I <br />~"' :; :" ~ . <br /> SAMPLE <br /> MEASUREMENT <br />'r~IIP 1 1 QIO#t>Cf b' >!t<I~~~~~ rT?r • <br />. <br />; ~rk~/[t~s!e ~ <br />~ ''~'4L}• ~4'; <br /> PEP.MIT , <br />.._~ <br />, ~ <br />,~pl,'J,?+IT ': T,IjG VALID REQUIREMENT hah:, ~~ ~n~ ~_: ~t A;<r Mf1 •~ <br />' <br />. 1: <br />1 (1 ~ <br />^'1 T 1 Z 1:A•^.-lr f:?: fx Ct': rY f`:~ r ~ <br />~ <br />, <br />. SAMPLE <br />:'I;k'C1jp%•~ MEASUREMENT <br />>> 1 ._rr~:-. n~4r.:t-"# d -. .: :)"~ TONAL..,. " 4r V^'/ r <br />~ r,a,~+ <br /> PERMIT <br /> <br />n cl, Itr~?r -~.~~.~ r/~~Ir^ <br />REQUIREMENT <br />,::f',.. y <br />..s..Q Ar~. <br />} ~~ AYG <br />!!Y 7(1 AV <br />.rr:~- <br />N74•r•I <br />',O ':h a ... -•:Yp^ef ': ! 1~I~ <br />r SAMPLE <br />: ~ T NT T~ •~ I Y ] j r ~ •7 L V ~ MEASUREMENT <br />`11''i 1 r1 IY - rt-. ,.... tt Y:rt P?'ZONA ~ ~ ONAL I Vr'°/ qa:: <br /> PERMIT <br />.FpL11ti~IT '^;)" YAL'" REQUIREMENT .. ~'T ~ Aq ',/r y(],,•rer <br /> <br /> SAMPLE <br /> MEASUREMENT <br />~ -'. ~ ~ i J~Q.',: : ~ .K, f"i'+V- •.. rl ~{+ 7V' T ~l. 5 ! '. <br /> PERMIT ' <br />t t.ar, vl^ .Rr1J~ VALrI'• REQUIREMENT ":~. <br />,.1 ZMC'^ Y1. ~ : r 'n'IT <br />" •) <br />• SAMPLE <br />n . • ~ '! v I IJ c ^ /~ y R .I MEASUREMENT <br /> <br /> <br />'"°L'f"' ;° )~S V,>1L JP PERMIT <br />REQUIREMENT <br />JT^4 A1'~~ <br />:'3QDA AYr: <br />DAILY tlY <br />'' /' <br />*f'1V°9 <br /> <br /> SAMPLE <br /> MEASUREMENT <br />?:~ t'! ~ r) n r >p;n r,.r~,>< Op'• Z:7Vl1L~ 'ri O 42'+VAL !ICS/ R.4 '' <br />_ <br />r'}~, f: r,; j' _.775 V.4 (,., :: PERMIT <br />REQUIREMENT <br />... <br />r~R T:j 11 PG . <br />, <br />••~~~~{{ <br />~~;KV 6A A4r <br />D!1 Zi.C y.Y <br />•., ~r. <br />M^V,,.u <br />'~ <br />~ <br />y ~ ~ ~~ ~ ~~ <br />• <br />- <br />- SAMPLE <br />~.1 I °' f '. ,1 ~ ~ 1t °, ~ 1 4 4"T MEASUREMENT <br />. ..c7 ' j <br />~ ( <br />~ r t: tit ..# ~ grY[,y V^Tq~; <br />' PERMIT <br />~.t.U'~t%l ;!t~5.; Y4L11~ REQUIREMENT 30bA A9G~ ftilTL1' :I{X ;'' ~ ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LPw THAT I HAVE PERSONPUV Ex AMwED TELEPHONE D A T E <br /> <br />A • ~ '`Y f ~ AND AM FAMILIAR WITH THE INFJRMATION SUBMrTTED MEREW: AND aPSED <br />ON MY INOURY CF THOSE INpVIDUALS IMAtEDIATELV RESPONSIBLE FOR <br />OBTPINING THE INFORMATIC)N. I BELIEVE THE SUEMITTED INFORr.1ATION IS ~ <br />~ ~/ <br />•L <br /> <br /> <br />N A A A ~r <br />TFIIE 4000RPTE AND COFIPLETE I PM AWPFE THPT THEFE ARE <br />SIGhIFICANi PENALTIES FOR SUBMITTING FALSE INFORMPTION INCLUDING ` <br />(/ (G/ T <br />O t2 O~7- ~ ~ ` I <br /> <br />4 9 <br /> <br />O <br /> <br />1 <br /> THE POSSIBILITr OF FINE arvD IMPRISONMENT SEE 18 u5c 4 loo( AND SIGNATURE OF PRINCIPAL E%ECUTVE <br /> 33 use 5 1319 rPrnulnes untlu Jlra aaures mar naluJC ^nrs uy r <br />~ AREA <br />TYPED OR PRINTED anJ ! run / <br />SIn.nJO ,nJ or nr.lamum impnsrmm~lr of M1nwrcn r munlh.. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rrlcrcntt all aba[hrncu(s htrcl <br />.,'r~ 7F 'fJ ~ ~ `)^'R'. '" ^XTN~ ANt~nAL Y oc g~'-5! r/1.9 4/I =Ci'l i. 5 ^'1 b' NO LAT :~ .I ~'r /.,a i*.., .q-r <br />''r.. '1"R-:.'.V~ P? '!''-!l. ~?`° SAMPT.R -H!1[Y~TS F:)k OLL ,': (7aF~~r oc]!JI9F.D ZF 4ZSIFL? SDC:~ ry 1+;erar, .^ _ <br />-a IG'~ T 1 I T Rr'^T 111^M^ DD !!'T TT'CS ~G Y`rITT T?I •1 T1J T C C ^ DPT Y <br />EPA Form 3320-1 (Rev. 9-88) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 OOC 3 u / ~ 50513-17 u) PAGE OF <br />