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PERMITTEE NAME/ADDRESS (include Faciliry Name/Lacadon ijD fferent) <br />NAME `7I;1 R'L~, It; .:. <br />ADDRESSNJi3fH THOMPSDN CHC('K 'tiNi:S <br />Ll6if ~D'1PA55 DitIV°, SUITE' 1J1 <br />.'. .`iANi) ]Uti=1'IJ:; CJ B1.5D6 <br />FACILITY <br />LOCATION•Ai{it()NDAL4. CJ H1623 <br />~. n.. r v n...~~ rn..cn: n•r :ar <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />n r <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEA MO DAY YEAR MO DAY <br />FROM TO 0 =% 3 ~ <br />Form Approved. <br />OMB No. 2040-0004 <br />(SJdk :C) ' <br />'"` :-'fININ6 lIUMUFF SEGI Pt%9D <br />•:l DISCfl~RGE ~ '~''~• <br />NOTE: Read InslrUQ{L4ns before c mpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION ~ *+' NO: FRI:ouENC SAMPLE <br /> EX of TYPE <br />PARAMETER <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />avaLrsls <br />,. SAMPLE #-^-arx{:i ^ :.~{.:~ .. ..::i: ( 12) <br />~ MEASUREMENT <br />UUII'J7 1 U U ';:P~3Ml~ ~ <br />. '~r itlk~li~ ~;~~.:#Rt)){~t ##c: f. '~ - <br />~ I( <br />~~ ~• <br />cYFLUt:YT C,HJSS YiLU , <br />~I~25UfREM~NT - dt=:t3 <br />I~U!! <br />7E ~~~ <br />su ~ <br />~JL1U5, SETfLCAiL~ SAMPLE <br />... .. <br />•••-' ~^~"~'^'= ( 2`--) <br /> MEASUREMENT <br />(, ., 5 • 5 1 U U ;~',-(? Mlt?° ~. <br />~ ~.'- .tk54>~S <br />~ -. ,9Ct~?~'y$ ., ~.~. X:.:-: . ~~~#L - <br />R ~ :~ .~. <br />~ ~'~ <br />"~~~., <br />,. .:~` <br />n..•-. <br />.:Yt~~1&t:f t;HJSS YALU., EMENT <br />R~Qt~ _ - RT~Y"'~Y '~XQ~'`. "!L L <br />7IL r: :;ti':A[i:; SAMPLE ..:P::'- ,::r::e;;;: .:;tta#3 j'ffi#t:';<fe ( I j) <br /> MEASUREMENT <br />(1 U 5 S 6 1 J U = <br />``f'~AMI't``, `.9i#i 4+3t#~#& . ~. .f.: :~ <br /> <br />~ <br />ii ^ ~ <br />~ <br />• <br /># <br />dFP'L'lF:NT GBJSS YALU} ; <br />QUI}'16MENT - ~ .. ~ `:~'~: T `'~ <br />~ MG/L ~ <br />~• <br />r LJw, LN CDYDU IT UR SAMPLE ( '13) ~ ~ ~~ ,Ot##~•#i: v#:7r ra<_t <br />': ;f d!1 I't{EA TM F,NT nL_q (( MEASUREMENT <br />JU~~ 0 1 U U ~"e'ti MIT' ~'R$R4~ ~ Ri&$O&'C~ ~ ~#fi~'~"'.~ ., fir k - t'. <br />cfE'LUF;^If vKJS~ YALU . <br />fl~Q(11REMENT 30D~ AYG bAILY MIC ':;.^ .~'... '~`':, <br />>>LID5, TOTAL SAMPLE ^^ '`~`'`^' ' ' ' ' ( 1 I) <br />D 1 5 J L V; fi MEASUREMENT <br />102i~ 1 J U ~-°PERMY~ a1F~tc f #tn4#Oflr a~~~•- Fr~k#~%tOt.-:' --~.,. ~,~,, <br />:I••FLUEAT GdOSS VALUE ~QUIREMENT ..F ~ ~' M~' L `°" <br />)IL ANf~ Ji?EA:i P. SAMPLE -r; ..^^,:}is ( 9il( ,r,::: ": dt###'k:: :<#+~;~#"- <br />V I S U A L MEASUREMENT <br />~ <br />''IJbb L 0 D Mlis `- <br />~-{~ .~=aFa'gq## ~. ~: ~ L'S_] - f4t R(K3 ~: ';r;.: ".; '~`:F ~' ~+,. ,~ <br />~FPLULNT JkJ.iS VALUE ~ <br />AE'C.1bREMENT Ifl~'p !".AE " 1= ` i~ ,~.-; <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> 'i~ RMIL <br />~ <br />~` <br /> REQUIREMENT - ~ L. .. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICertiry under penelry of law that this document antl all anachments were TELEPHONE DATE <br /> ervision in accordance with a system designed <br />r m <br />tlireci~on or su <br />tl <br />tl <br />r ~ r ~ <br />G y <br />p <br />prepere <br />an <br />e <br />to assure that qualified personnel properly gather antl evaluate the inlormation <br />stem <br />n <br />wh <br />mana <br />e the s <br />f <br />h ~ <br />r+ , <br />g <br />y <br />e person or perso <br />s <br />o <br />submiHed. Based on my inquiry o <br />t <br />the inlormetlon <br />inlonnation <br />th <br />bl <br />f <br />th <br />i <br />di <br />l <br />! <br /> , <br />y responsi <br />or ga <br />er <br />ng <br />e <br />orthose persons <br />rect <br />e ~ ~/ /'u~ <br />' <br />' O~ /v ,J <br />V~ S submitted is . b the best of my knowledge antl beliel, true, accurate, antl complete. / SIGNATURE OF PRINCIPAL EXECUTIVE i <br />Y <br />r <br /> false informason <br />for submittin <br />lti <br />i <br />ili <br />l <br />h <br />h A <br /> , <br />g <br />gn <br />cen <br />pena <br />es <br />I am aware t <br />at t <br />ere are s OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED Inclutlin the sibili olfne and im risonment for Mnowln violations. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Helen:nce al! arracnments nere/ <br />•--:LE;d:iL£ SOLIDS LlttIf +ILL itE AAIYED F9H >LJ-YR, :1-H:i e'11PCIP eVE:,T-.PC LP..2, PG IY, F'OR R~'QUIRE"::STS. <br />. •i7::LT SAi1PL1NG INSTkU~TIDNi-I.C.9, RS i%. 3U DAY AY IS HIGH::ST "•C)tiT"L'! AV`; DURING PF.RIOL~ REPOk'I':iD. <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. IS I A 4-PART FORM PAGE OF <br />OOlua/0007 11 33 1 <br />