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PERMITTEE NAME/ADDRESS B+dw+irWryNawdrar,nw IJDIaGrxp NATIONAL POLLIlfMT OIBCNMOE ELIMINATON SYSTEM INPDES) <br />NAME ~ -~ ~;, .-. . , .. L + vJ ` DISCH1 R6E MONITORING REPORT (DM9) <br />t~. <br />ADDRESS :v t * .- L ,• .• r • I' ~ O ) f` " I ' (+ !) O ~) A <br />T1L r:•1 ;, u~ u A r E ~ ~ I 1 PERMIT NUMBER DISCN.ADE NUTA9ER <br />'--~-~-1=~~- ~' ' " <br />E. "' ` • ° 11 ~ ~ rJ ~{lll I ~ MONITORING PERIOD <br />FACILITY .1 q • .I~1 P ~ ~ ~. ~ - - . •,--• ~ q MO OAY YEAR MO DAY <br />LOCATION~~~ 1 y y -,~, FROM 1 TO ~ ~ % ' ? <br />A 1"''; .l iu S-r_ ~' 4~~ ~'l I ;1 '7 c. a 1. - l9dlll n9oal n~T n6J71 /J8-J91 130.311 <br />Forth Approved. <br />- ~ , T ; ,. •• ~ . ~~ =OMB No: 2040-0004 <br />Approve~expitpe OS-31-8B• <br />NOTE: Reed inetruedarr before completing tlde form. <br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING Grd Oniyi QUANTITY OR CONCENTRATION NO. FREOUENL7' SAMPLE <br /> !4663/ /5461/ 38-15 !46-63 151-6/ EX OF TYPE <br />!3Z 37/ MALV515 <br /> AVERAGE MAXIMUM UNI MINIMUM AVERAGE MAXIMUM UNITS reJ~es~ !6466/ l69-70/ <br />,.I SAMPLE _ . .. ( '] <br /> MEASUREMENT <br />. I,, j,. I ,. .. PERMIT ~ .. ..... ::..; E. ...t.rsA .R ;: <br />'~ . ., ~~~ bfi:r-. . .. 'n.!i .. .v'i Y '. r'!'1' <br />r.;y.,: .. ; .;,,~,~ qti„!: REQUIREMENT ~~ . <br />~~ .. .HT~ P.R.i(~rY,?... <br />•)i._ ti, iTAL SAMPLE ~ ~`?4107frc ! ~~'') <br />.; ~ <br />,, MEASUREMENT <br />; <br />~(•, {:., ~ n D PERMIT :>:<~ _ :r' ._ ....-r.,y r ~ .. ^~tt': :~~ 7~ ..,.~ ~r i~~p s; <br />y-, ,I .'''-' ;O`]S i VAi.'tr ;REQUIREMENT <br />~ ... <br />~ <br />..: . <br />5::~~0'~ ~ ?LY:~ .[~AX?..t "!.~' . /, y;•. s'^`~f <br />:. ~. ~ ~ : 1 " ~ I SAMPLE .. ^... ., _. ~ :..,:. ~:r, l ~ ..7j <br /> <br />I MEASUREMENT <br />{/- <br />;I' ,~, ~ p :~~PERMIT <br />... <br />...., ^.:~~ ...hNV r.: <br />~ ~' ~:,•.. ~ pcP; :.'< ~ '..~.. <br />~. l~ :. :.. v `- <br />~ .I;, 1:~/ ,;r~; <br />. ~ : , ..:. • c .• <br />.. f ... D S 5 V d L I I . 'REQUIREMENT <br />.. <br />. ~ 1.. :I <br />, ~ ~; 1 . <br />P: : <br />,.. <br />... ~13A -•k 4+': .... .. <br />' ~II~A`LL.'[ ..% J ,~f?.. ~.•,> <br />, <br />)ice .. ._,~~A~p SAMPLE ... .. ~/ ~ ' rty..~..3;:r: ( ~ :] <br /> MEASUREMENT <br />' 3 ': i I U B ' ::.PERMIT Dr;:. rr,: ~ .. ... ,..-,. ., ,~ <br />.. ., ,,. -: .:., ., .r.,. T,: e,.^^T~ ~ <br />@ ~~.'...::.:.: :.. . .1 ..,, T,q ,.;i o <br />NALiI~' <br />" <br />'' <br />;AJ <br />` <br />(`' REQUIREMENT ~ - ~.~j <br />YS;'r~' <br />Nll <br />j~ "~~/r <br />r <br />;. <br />i <br />. <br />, <br />55 . . <br />• <br />. . <br />', SAMPLE r 1 `~^'~ <br />'i !, ? .. .: ": ~ V r ;. I. t ~ T <br />• MEASUREMENT <br />~J.1',.+ ~ U :i :PERMIT ::~' ~ F;'r1}a.. .:.POti:^ ,•, ,: :'. , e;r•x^>'s:` f'•'~~Ry~ER?r~:.~,:~ 44^ ~P:~:r:(,Y ('.,I ;.~.A, <br />v r ~ , . ,, 'r ~ u 11i ` v" . (, q c ;HEQUIREMENT~ :T'J Dai. ~ A P 1x - ~ .n~~ I~L.Z" _ ~ r, ~ <br />~T <br />. , . <br />L ;. '. ~~ , ~I F. A °_ SAMPLE .. .. .. ( ~= w ] <br />1. L ; ~ I • I. MEASUREMENT <br />','li,•:', I (' q :~~ ~PERMIT~:.: ~ ~ D4: a7:=:x ^F.^C)(?ry'' i ~.-_T r;•t'.:,;..,. ?-:::'.::y.r: k:;`.;.:.;.~ . .:.,.. ...: ..~,carT.Y V~ "'!k: <br />'~': ~"'-v~ :',a9i +'?L'1~ REQUIREMENT ~~ ::I''7ST ~M i~{~ •_~ .. .., ' <br /> SAMPLE <br /> MEASUREMENT <br /> '~'~ PERM,IT.~..~. ..... ... ~ , <br />.; :~. <br /> !REQUIREMENT. :~ ..... ......:..':;::;':':' :•':•;;:'~ ~ ~" <br />NAMElTITLE PRINCIPAL E7(ECUTNE OFFICER I cERn FT UNDER PENALTr of LAw THAT 1 NAVE PERSONALLr ExAMINED MD <br />MD EASED ON <br />FORM <br />ON SUBM <br />TTED NEAEIN <br />MI <br />M <br />TH T <br />E <br />T TELEPHONE DATE <br /> ; <br />AM FA <br />LI <br />WI <br />H <br />IN <br />A <br />I <br />I <br />MY INQUIRY OF TNOSE INDINDUALe IMMEDIATELY REBPON4eLE FOR ' <br />~ <br />/ 4 <br />~ <br />` OeTA1NIN0 THE INfORMATION, 1 eEUEVE THE SUBMITTED INFORMATON IS ~ :~ <br /> <br />' <br />~ ~ <br />I <br />TRUE, ACCUMTE MD COMRETE. I AM AWME THAT TNERE ME <br />INCLUDING <br />pONIFIDMT PENALTIEe FOIL 9UeMITTINO FALSE INFORMATION ~ <br />~', '-~ <br />" /. ~ ~" -' <br />_ <br />•, (, ~ , <br />THE POSNEIUTY OF RNE MD IMPN90NMENT. BFE 10 U.B.C. E 1001 MD 77 l ~ ( ~ ' ~" 77 ~ 49 c { ? I <br />Pm OR PRBYTED rv ~mF+Et+wn ~ ~ ~Mnrwr s~mvl~ a,~ ~i'.~'•.!F ~ p f 10~~ EIpNATU11E <br />OF PIIINCIPAL EXECUTNE <br />OFFICER OR AUTHORIZED AGENT A A <br />CODE NUMBER YEAR MO DAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLA I IONS lMlrN~nCe e// emenmenra nlre/ <br />1^ Y .1, s'. ~' 1.. 9lrn ~ '.~!, .:1 LY AY ;. ^"'; ^ , ~ .. .., ~ _ ... ,. .'.. 7, ^. "1. <br />EPA Fwm 3320-1 108.85) Prsvioue editions mey be used. IREPLACEB EPA FORM T<0 WHICN MAY NOT BE U5ED,1 n - r , PAGE .OF <br />UC. /.~/)r 113-7211 <br />