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PERMffTEE NAME/ADDRESS (/ne(ude Faciriry Name/Locarion i/Digermq <br />NAME ~ v i, - .- ~ .. _ :. <br />ADDRESS"?. ,:c 1 9? ~ -,,its ~ ~ v..~ nv <br />-• • - <br />FACw7Y ' <br />LOCATION <br />°. 1'v: Psi:.. ~Ti . •r,. r1•; -. al ,TUd <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-0004 <br />(zael (n- el .. , .. . <br />Approval elLpires 051-88 <br />PERMIT NUMBER DISCHARGE NUMBER <br />n • n'T +~ <br />MONITORING PERIOD "' . " ~ '' "^ '~ .^ - ^" ~~ rn - ~ r r r• -~ ~ : -~ <br />YEAR MO DAY YEAR MO DAY <br />FROM '') T' ~f TO ', •, ~, ,~ r-,. ,. .., r., .. r.,1, _.. I__I .:r ;: <br />(zaz1J lzz,z3( Razs) (z~zr( rzszp) PJ631) NOTE: Read Instrudlons beforetampleting this form. <br /> (3 Cmd Onry) QUANTITY OR LOADING (4 Cold Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 45.53) 54-61 38-45 46.53 54-61 EX OF TYPE <br />(32-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />ryze3i aNUYSIS <br />(54.88 <br />6370 <br />n 1. r, LIC ~'`.1 r..Y SAMPLE ..{-....C :'S?.~ .. r... ,-.... <br />~ _ ( t 11 ~ <br />~ L <br /> MEASUREMENT , <br />3 ~ (~n ~~(~ . ~ 7/ ~ ~ ~~ <br />I'U;l ;'I D J <br />PERMIT, <br />ClL10r4R0 f. <br />~ 4 a00R" <br />f,. ".G #~4fr.~FfX'4~;'. 6,BR"~'. 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TT <br />, `A <br />, \ ~ <br />J <br />~ r <br />:7=~-r F. `J(',,;'1 MEASUREM <br />N `-'n. i. h R1f` N ~ <br />1C <br />G(!530 6 0 7 PERM~~ Gb04!0 p° '004`#4'# A ~~":' c*Yxph+k <br />~ R!?4Qp 1' QPbT^To "+~ w ~ <br />' ~7!i4,'l5t5 31'(."'+ REQUIRE" NT .,°; .: .•'-.Y ~e ~ • v -/, '~ w <br />' :~I D.'i 7JT+IL SAMPLE S'e##.4# <br />~ '::s :`C"--': ':h'F {-'-~` <br />~ , <br />f •i1 <br />~ ~ <br />J~ <br />~~~~' <br />':G ~t c4DL:D MEASUREMENT ' ~ ~~ .~ ~ <br />~ <br />p0. i9 I (! D ! PERMR - <br /> <br />• OcOKs d'## r: ;: r. ( <br />h - <br />is <br />rry <br />r <br />RRF6'`"/" `~ . <br />~~t~'_v <br />;I•'~. !LT :;RJ5S Y4'.~ REQUIREMENT ~:. ..•r.• - n .~ n~rf w w• <br />_ w. <br />`~1Ji.1 JS, SMTTLI''0..,r,' SAMPLE O:YRrcH;= G^.',r.:`-4t: n:k¢~':•• q f <br />, ~, <br />~ <br />\ <br />~ <br /> MEASUREMENT ~) ~ ~ <br />r() F1 ~ ~~ ! <br />~ ~~. <br />I)JS4S 0 D ': PERMIT 4'#14 "r00 -?7k$0 ..... ,, a(C'~~Y+lkt•-# ~-',"~-ip-~'Ir"- <br />s <br />~' -. '~" !)'4@b'" <br /> <br />~ ., <br /> <br />~~ <br />~ <br />.. ~' C O "" •Y F F: * i "' 1. 7 N 9EQUIREMENT ; c., ~t~,`xf`- Y-'.; : n r <br />t ~" T ~ r i - w ~ <br />- <br />`~rlLI11~4 5 .P'"L''•,'LF SAMPLE -. :`3 Orr.}r.-`.: nra:;: ~': J~ ' <br />/n~ f ,!-~ / <br />3 /' <br /> <br />MEASUREMENT l/ <br />I <br />\l/ O <br />] <br />I)'J54S 1 i 7 ,'''PERMIT teh IRRRO ~d4~Q Zia st fry 1~#iL'1'f# r"Y1.~{'1 ()S!'t '_ R~nT~F1+ 1' RR}'fP <br />C ~ <br />iR~l' <br />F L rt F F. i ~: f? n C ~ ~ 4 L r. a [REQUIREMENT ;e t - - fl l ^ n T f ~• r ~ r , <br />at ~ <br />- . a" ~= <br />~LC G?::\°r SAMPLE <br />ENT <br />M F,.,..r~:~ ~:y:.r..,.. :.rt«.~ ,.~.~,.,:r. <br />~ 1QC ~ .,rT ,,\\ <br />~n <br />IJ rk <br />~•) Q <br /> EASUREM <br />11Dti~1, ] C` ~ PERMIT ir4sY044 R44OLt0 r^.,. Q#OO~D ##+f$Yaly <br />0 <br />~ ~" <br />')'YiN <br />. <br />1 `,; <br />~~ <br />' <br />,_~J~~JcL'^ on ;.-, ,rTr .T,- REQUIREMENT .'c r,t - ,-T ^ r r <br />o T <br />. ~: <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMnTED HERE NALLY EXAMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL <br />7HE INFORMATION, I BELIEV S IMMEDIATELY RESPON <br />E THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, ~ j <br />`/' <br />//' ~ <br />/ <br />/ <br />rcl "Ill <br />ir <br />P <br />h ACCUf1ATE AND COMPLETE I AM AWARE THAT TH ERE ARE SIGNIFICANT <~ <br />/// <br />~-' ' / ' <br />_ <br />. <br />s <br />8 . <br />S FOR SUBMRTN <br />AL G FALSE INFORMATIO N <br />INCLUDING THE r <br />iJ <br />/ ~ 7 <br />I <br />E-lvlronmenta .'-+z:naner <br />- PEN <br />TIE <br />POSSIBIUTYOFFlNEANDIMPR <br />rettle <br />ndo, th <br />318 <br />e s <br />Po , <br />ISONMENT.SEEIBU.S.C.41001AND33U.S.C. <br />me <br />cl <br />m Slgapp <br />mtt <br />t <br />I <br />de fi <br />tl <br />$IGNATUREOFPRINCIPALEXECUTIVE <br />97Q <br />n7D-2712 / <br />/ <br />' ~~ P <br />/ <br /> <br />TYPED OR PRINTED y <br />r <br />v u <br />es <br />u <br />as <br />n <br />u <br />nes up <br />en <br />. I <br />ar <br />4 1 <br />mex/mum impisonmenr orbeA.e9n anrondu end Syeers.) OFFICER OR AUTNORI2ED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (HBIBrenCe all eaaonmenrs nemJ <br />„" i4r. • LT•r"_ `'-~_ _,~ -r„.'+`.r. .7L7".. ( •...I •n(•rv n..~y .c (- f,_v^ 7q n m <br />.~ -p c--~r•-~ rt. .,.. T <br />,r y.; .I (. •7 r.. T.T nn T; IIU' na n n T9 NrR' c ruc ~+/, . <br />,. .hl _ • -'i .M1 ~ ~ F,. J'.. '1 l." "l'J F T~ l•1 Icr__.-rC v.~/`,'^~ ^. L' !T- <br />1 i~ <br />EPA Form 3320.7 (ObB5) Previous ediUOns may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF <br />nDi n1 /nT nq1 ~_1 S)q <br />