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PERMITTEE NAME/ADDRESS (T,.idr Fsd~ryNa/lau,m UDI$ m1) NATIONAL POLLUTANT DISCHARGE DJMINATON SYSTEM /NPDESI <br />NAME a' [/ ~ W'- r Q DISCHARGE MONITORING REPORT IOMRI <br /> ( I7-16I 17-191 <br />ADDRESS n~a ::LS !I"F' C'1000 90 009 A <br /> Wb1 S $. lJ /~~ er / ~ 11'7 Y _ <br />--PERMIT NUMBER DISCHARGE NUMBER <br />4~`!-111 ~-f..~. ~Cr a?f'r-~y}~y1 Cv fjOL37 <br /> <br />FACILITY MONITORING PERIOD <br />' YEAR MO DAY YEAR MO DAY <br />LOCATION <br />S.M CUd~'f' L-Q HLD 91 FROM TO <br />A T T Y : .1 [..'-, R F' R A L ~! -. R. l76I11 lI7-731 I7L751 /26171 l7B-791 136311 <br />Form Approved. <br />?+ i !' ~ W A T 5 0 '" 0 A n ;OMB1fJo.~2Q~0[OOR4 ~.. <br />{ SFI P p ~ p, _ - _ - - APProvel,yexpi{eLSS05-31?98 <br />p - PINAL ~ <br />'INhP <br />a^~' NP DISCHAT/I~r ~__~ ztna= <br />NOTE: Reed InetruNarr belpe wmpletinV tble form. <br />PARAMETER !3 GrO Ontyl QUANTITY OR LOADING l4 Grd On/vl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> !06531 /5L611 /3B-<bl M653 /51-6f OF <br />l31-371 EX <br />ANAtrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l67.6a1 /66681 /69-701 <br />i',7 SAMPLE F:p7RCT a#aar~^ --~~>z;; { 1?~ <br /> MEASUREMENT <br />UU~1J!1 1 0 '1 '~: PE~MIT~.:~:~. ~~:~ QAr#~$R~#.:~::. <br />~ ~~~'01~4~a4r' ~ <br />~ Cta ~(~:e51:.~ '~: ~.:.. ~ . ~~~9r}><eL*'AIR..: ':74. ~. ~.:~ Y':'¢7{7.~ ~N5.TT1 <br />FFFLIJ2`1'. .;R7:,4 VII L'I. ,REQUIREMENT ~~`...~ .~ ..~.;. <br />.. -`~>rp A0T1 ~ ~~ ;~~rit:~7 ^II <br />_i :)LL DSe T1TAL SAMPLE {r'F Ofi:h S#40 h.^- .'~;t 3t-M1G { ~q~ <br />y U ; P f; X11) s, i, MEASUREMENT <br />/J U 7 J 0 l 0 U :~:::~~.:eERntl7:.:~.~~ ~ ~ tr~~al'Cai:pO.:.: ::..;..s~PabR.~~: '~ <br />~~ R cr ~ aolfzfrc~~ . . ~5... . . T..~ ~kC{~f ~~ G?tATI. <br />1.F`LUt:i1T. :JNDSS VAl.il :REQUIREMENT: ~ :..... .:. <br />~ ~~~~ `~ ~ ~ <br />:.: :.. ........ ~'~~ <br />~~~ ar:f)p .. `:. .. .. ~ kf'.r ... <br />S ')i:F T~li.aL SAMPLE aR aaa# OahO ¢'k L: .^. 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ANU ':HFASC SAMPLE 4tRt-x3 ~PCC~T .'X x;'^->St ri:~4b:;::` { 1/1) <br /> MEASUREMENT <br />Uj5'Il 1 0 D PERMIT.:. <br />~ Saag;r~l <br />~ ,.: as>ar~laa : :a:a aa,;rasTa a>tr,R90 7.'0 ,;a.~I:Rj r,R9lR <br />F'FLUFNi "~R755 ~~LO? ,REQUIREMENT~ ,. <br />~~ ~~~ ~ ~~'~ <br />.:.:..: ., <br />aTz*Ay ~ - <br />.. ........:. <br />:. :. <br />IB.ST "lx.>c. <br />x•;/L <br />;:~;ga(q!.: <br />:. <br />FL'IJr I` ~,7R0!IIf DP SAMPLE ( q3) !`-;sFe}trv v}q rts^.. Y,~ CYF~r ~. <br />^; 11911 pgq>•.i Rc NT p(Aq EASUREMENT <br />'TJUtiI) 1.. D U PERMIT.. <br />,.. flLP::ORi ': it$:?01tt..: ': btyOAA. *.;;-.^•.d?,: <br /> <br />~ ~•~t~:.~~,. ~•,•. <br /> <br />- 7!,ERL S7T5TA' <br />Y?L~Ih'`i" SRD^-`; VALII /REQUIREMENT: ~lUpk:<.S7a~. :..'[I~F~Y~L:~~:;t.1~` Flrn :.... ::.~ ~. ~ .:: <br />:. :~. . t.y..« ~ .. . <br />,i Ll. A.HU •e I'.PA i°. SAMPLE hiC-^:: { ')4) ~G:I '3 CY-.^- ~-~"'s'-•. .. <br />`) [ :: 11 A L MEASUREMENT <br />;:UJbh 1 D f) ..: PERMIT.;..:~ ~ Y~.1z:6 ax a.•:. .:.'TEP~062~.. P~-; ~ KerR01.{`:: KY:=, r.4 <br /><' ~: r::;::.. ,« <br />'~ .. y.. <br />`• ~- F~YR~i, YL!iFI A' <br />°'FFLUF'~IT, :k:15i VAI.IJ /REQUIREMENT: . """ ' <br /> SAMPLE <br /> MEASUREMENT <br /> :: ~:~~PERMIL; ~ ~. :.~~~ ..:::. <br />~ ... .. <br /> ;REQUIREMENT- : - ~;~-~-~ ~ ~' ~ ~~ ~ ~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERTIFr UNDER PENALTY. of <br />AM FAMILIAR WITH THE INFO uw rNAr I NAVE PERSONALLr ExAMINm AND <br />RMATION SUBMITTED HERDN <br />AND B <br />E TELEPHONE DATE <br /> <br />~ LV f)/J-~ ~ <br />S• ; <br />AS <br />D ON <br />MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPON518LE FOR <br />ORTNMIMG THE INFORMATION <br />I BELIEVE THE sUSM17TED INFORMATION IS <br />_ <br />" <br /> , <br />TRUE, ACCURATE .AND COM0.ETE. 1 AM AWARE THAT THERE ME ! <br />1 <br />~ <br />a <br />~ ~ <br />{-'C~' <br />1 M <br />t / <br />6 SIGNIFICANT PENAlTIE3 FOR SUBMITTING FKSE INFORMATION <br />INCLUDING . <br />. I <br />I \ _. <br />~ n . )- <br />eY. t + h . <br />THE POSSIBRJTY Of FNE AND IMPRISONMENT. SEE IB U.S.C.f 1001 AND 77 <br />1 <br />S ON <br />~~ ~`1 <br />-I l~-/j C O ' <br /> u.s.c. f rate. rnww• uw u.rr mnm,,..v `,cwa, r.». uP ro t roooo ATURE OF IMIINgPAL EXECUTIVE <br />TYPED OR PRINTED nW Or nrrhllnr uneWlaulnNnr olMMwn enonNi rW6heal OFFlt:ER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />iu...l7AY^.4Y~RACt~..IC°'i7,Cr:J:in,.q~,1T~ILI,..gV....,r 1)°[C;rpl`PIOF~ Q.gpnu~ .. ^I.. ~ - .. T.~'.'. ~. 7. <br />EPA Form 3320-1 108-95) Previous aditione may be used. IREPLACEb EPA FORM T-40 WHICH MAY NOT BE USED.) ,7 ~ ~ / , ~ ./ / / :~ 1 ~ _ 17 ~ 1 PAGE rOF <br />