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PERMITTEE NAME/ADDRESS pndrde Faeiliry Name/Locafian ijDi$erenq <br />NAME 9L9EF: ;:, .I4i:. <br />ADDRESSN;,NTH THD"PSDN ChE6K "'INc~ <br />L/bU .:JP:PA55 DIiIYE, :iUltt fill <br />~iiA,9D JU4CTIDN CJ nLSUh <br />FACILITY <br />LOCATION:SRr,ONDA L~ CJ y1523 <br />APPN_ .I. L`_ K'.'lV"+ r'nu cn! Tr Nr >>; !-__ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMRJ <br />x ~ i .. <br />i PERMIT NUMBER ,. DlscklaRGE N' fl <br />MONITORING PERIOD <br />Y MO AY. YEAR MO DAY <br />FROM TO ~ ' 3 t <br />Form Approved. <br />OMB No. 2040-0004 ' <br />='J~ - <br />fiS ild~ GC) <br />- FINAL "I'".v <br />`16L P, 007 CO!13IyF.D D.;CFIaI; <br />~g'~''-Read Instructions before completing this form. <br /> QUANTITY OR LOADING `- ~ <br />.. <br />~ QUANTITY OR CO TRATION NO. FREOUENC SAMPLE <br /> : <br />..b' EX OF TYPE <br />PARAMETER <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />aNnl'>SIS <br /> <br />::IL AN/i ~l/EA~F: <br />SAMPLE <br />`'`^#'T +' <br />( Jy) <br />:fi::::fir ~r <br />r:fn;: zt: <br />/~ <br />Y' i <br />~ <br />/~ <br />VISUAL MEASUREMENT <br />t'uvDh L J 0 ;., ;..~' ai~, E5=1 ~_~ <br />.. :.~+p+1K~ x:c <br />I t'PLUt.NI Gri C',~ YALU QEM&CJT -' I~I~~,: N0=0~ .. t::aa "~ ~ ..:. <br /> SAMPLE <br /> MEASUREMENT '''' <br /> ~fk'RMIT:, . ~ ,r:s <br />` .~: <br />'~ <br />' <br />~ <br /> REOUIpEMEN7 , ,I, is x+~'% + <br />. a <br />e,~. <br /> SAMPLE <br /> MEASUREMENT <br /> ~P~HMI7*~ <br />~ c ..~:~ ~ .a r , -, ~: ~slc: ~~ ms „~ - <br /> <br />flEOUIREMENT <br />- - <br />~ <br />.S ~ . <br />'=~ ~+'~ '~ <br /> SAMPLE <br /> MEASUREMENT <br /> 4 _ 4 .. ~ ~' W ~ ~ S~' <br />~~ <br /> ~{EOIlIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> AE2IUIREMENT :~~-°":` ~' <br /> SAMPLE <br /> MEASUREMENT <br /> - <br />J _ _ _ .. r~ ,~, ~ _` <br />~ <br /> tI~4~EMONT . F,~; ; <br /> SAMPLE <br /> E N T <br />M EA <br />S <br />U <br />R <br />E <br />M <br /> 'j <br />~ y <br />R y <br />y <br />~ ry <br />~- <br />~'.~.''i'CT1MIl .. `rz'. ~i ~yti tYt ~. <br /> REOWREMENT <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I Certify under penalty of law that this document end ell e[IachmenLS were TELEPHONE DATE <br /> ervision in accordance wgh a system tlesignatl <br />r <br />r <br />ntlar m <br />dtrection or su <br />tl <br />~p~~/~ <br />cal p <br />y <br />p <br />epa <br />e <br />u <br />to assumthat qualifetl personnel properly gather and evaluate Melnloimation <br />stem <br />e the s <br />n <br />r <br />esons who mana <br />f <br />B <br />I <br />i <br />h <br />f • ~j <br /> , <br />y <br />p <br />g <br />e perso <br />o <br />submitted. <br />ased on my <br />nqu <br />ry o <br />t <br />the IMOrtnation <br />atherin <br />the information <br />for <br />tli <br />U <br />ibl <br />N L <br /> g <br />, <br />g <br />ose persons <br />rec <br />y respons <br />e <br />or ~~ ,/ ~ <br />`Q5' <br />D / DO ~U ~ <br />~YLus submitted ie . to the best of my krrovAedge end ballet. true, accurate, and edmplete. SIGNATURE OF PRINCIPAL E%ECUTIVE V'r • <br /> I em aware that there ere signniwnt penalties for submitting false information, r <br />OFFICEfl OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED inclutlm the ssbtli olfne and im risonment for knowin violations. <br />COMMENTS AND EXPLANA I IUN OY ANY VIULA I IUNJ IrlelemnCe au aRacnmenra nere) <br />.'ch"ITTEE !''.JST ': 0'T IFY ~JCD 3U DAYS i'~IJF' ^~ CO'1RI NItiG f1'3C HA dG°5-F;:ii I.4, 4, P3 IY. 1".ONTNLY +A `1PLI hG FGR <br />.'", FLJN 1 ?St; .4LLOAEU :IUdIkIJ PdIODS JF LTC ACCFS:>; dTTACit STATd9C:iT °'~ uK`t, D'c'TCfIOH LIr,ITS-5P:E I.F.2. <br />I$1 `-PAYiT'FORNI` `PRGI?"' " OF <br />00134/00071 -1~~~,,; 2 <br />