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PERMITEEE NAME/ADDRESS pnrr4 PsW yN.r/Tnrm,a, yDlp w9 <br />NAME <br />~ . . <br />r <br />i <br /> I , <br />.. .. <br />ADDRESS (1,'. J- I . '..., <br /> F. ,. <br /> ..,,;, <br />FACILITY <br /> ~ I ' <br />LOCATION <br />a <br />NATIONAL POLLUTANT DISCNMpE ELIMINATON SYSTEM //IVPUfSI fOTf Apprero:.. <br />DISCHARGE MONITORING REPORT IOMRI 9.N0. 2040-0004 <br />/1-J61 J7-1s1 i. ..r' i, 1. ~ ±`,' 4 "_ :QI'!.) <br />" -I'1 t t <. r c 1', - ~ ~~ • , -, ! ~) APProva4 exP)iss 05-31-BB <br />PERMIT NUMBER DISCHNIOE NUMBER ~ _ <br />>.: ;. <br />' ' ~ MONITORING PERIOD ~ ~ ~' <br />YEAR MO DAY YEAR MO DAY __ <br />FROM ); ., ~: ".' TO ~: -.., I ~' _..G r:' ~ '~ -. .t > I__~ ... ~.~ <br />/zavn nazi/ JzA-zsi !zs-zn (zaa91 r3a3u ~ NOTE: Rud Inewetlom bNare oompletinp this form. <br />PARAMETER l3 Ord OnIY) QUANTITY OR LOADING l16rd ~~ryl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> !<6531 15-61 13851 !4663 !51-61 EX of T <br />E <br />l32-3)1 ANALVas YP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !17'e]1 !61-561 16s~701 <br /> SAMPLE ._ ~ .. ... .. ( ' <br />` ) <br /> MEASUREMENT . <br />. ~) 1 ,. PERMIT ~~'X ;:ie'g sus ".Y r+Fr ~~ ~; ~ <br />!~ ~ - ,j%; fir. aa~ `).rJ ~ ...~ti r..-t.j. <br /> REQUIREMENT ..SY 3N k8.~' iSH - I <br /> SAMPLE ; ,_ - i <br />r ~) <br />..'. ,, <br />MEASUREMENT <br />• <br />!- ~~'PERMIT ~ .., ^; NF.{S .tY ~ ','.-:Y.¢A'!!ifi+ , r'~GL`Y <br />v ' <br />3~ ~ 7LY I;T .. S. (( ~ .R.b <br />- <br />; <br />. <br />o- c .REQUIREMENT ~ . <br />~ ~ . <br />~ . ~ ~ . ~• <br />F <br />, .(. 1 <br />q I ..: <br />,- ^~.cp.i Ly, <br />~'`~.il.:~ SAMPLE .._.... . . ~ 'S) <br />, MEASUREMENT <br />. _, •1 `~ 1 :;PERMIT r . '.';.. :.. ~,.... h Rv ~:: A '~. P r j'-. 9 i L ~. , ~, ~ ~ ~ /' ; a p s, <br />I - :r q ., I s <br /> <br />~ ~_. <br />~ .REQUIREMENT ~ 7 L~, Y ~ ~ j. ~ r (il O ;[ e . / . ~T j `. m:; <br />.i <br />r ~ <br />r SAMPLE ~..::: ': ;:: '::~: ~.::~: f 1 ~) <br />, MEASUREMENT <br />I <br />l , <br />~:J7 ~, <br />~ <br />~ <br />PERMIT <br />~.. <br />.. ~i: {: <br />... .. <br />l..i <br />7•~~ <br />' <br />1.1: "~`.~~ <br />i~br <br />~ <br />r. <br />..; IJE,, 1'i. ',i~.. REQUIREMENT l7:)t Y:; G'II:"~ ,: .r <br />~ ..1,, .. )~J irl <br /> <br /> <br />' <br />. } ~ SAMPLE ..... ...:.... ., ,: :: ..: -: .: :. ,. .. .-..... <br /> <br />.__. .. :.:. ,.:.._: <br /> <br />. t 11 <br />( , <br /> MEASUREMENT <br /> <br />r <br />L ' <br />PERMIT. <br />~,.'.:>rC . <br />:,c...r::::t <br />- <br />{:+: , .. <br />,~ fir7 <br />") <br />~ <br />.1'I j I' <br />:1F.~? <br />- .. REQUIREMENT 't ; T . ~ ~ ~ Y ~ / ~ ' " T <br />,. L l ~. - ' L " ~ SAMPLE ( ; 7) ~ ~ . ... . <br />, <br />~ <br />. - MEASUREMENT <br />: <br />. : <br />Y ; ~ <br />r L <br />I PERMIT 'J ~ :!")T; p ~.!t ;a {:R:...±. ;,;-': k~.{r :... ~t :{; i,° ~ V ~ <br />>', 1. <br />: <br />n 1 <br />t . U (' N T , I <br />~ REQUIREMENT .. <br />_; ,l :?.i ~~ r .. <br />i- ~ I i Y "' ' ' " .. .. . <br />.::.i75, 1'. 'L SAMPLE ~ ~ ... .. ~. ... '-l <br />l ( Z )) <br />..i'~JL.Y'J MEASUREMENT (1/G ~J <br />l~r ~ v' <br />)!i i PERMIT r': t=;; ;: x:r,.; ::tg. <>::~??T .)}1; .) ar~L rRr y ,.; <br />= L U L"J :' I, n ~. ~ ,; REQUIREMENT _i 7 T `.' A Y : ':' n : 3 ri ~ f : / <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTFV UNDEfl PENALTY OF UW TMAT 1 NAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITN THE INFORMATION SUBMITTED NEREIN; ANO BASED ON <br />. TELEPHONE DATE <br />VyI 1~1 m ~] ~? e A f1 <br />~ <br />1 <br />~ '' <br />1 I MY INQUIRY OF TNOSE INDINDUAL9 IMMEDIAifIY flESPONSIBLE FOP <br />TAI <br />RM <br />TION <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />O <br />E ' <br />" <br />f <br />. <br />t <br />, <br />n ~ <br />1 Oe <br />NIN <br />TI <br />INFO <br />A <br />, <br />1 AM AWME THAT THERE ARE <br />TRUE <br />ACC <br />RATE <br />ND COMRETE ~ .~ <br />•~ <br /> . <br />U <br />A <br />. <br />TIF9 FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />GNIF <br />CANT PEN ~/ ~ <br /> , <br />SI <br />I <br />AL <br />` t~ ~ <br />/ <br />/ i ~ / <br /> / OF RNE AND IMPNSONMENT. SEE 13 U.S.C. F 1001 ANO ]3 <br />THE POSSIBNT gIDNATURE OF r1I1NdPAL EXECUTIVE /~1 ~ <br />~ <br />' ! <br />1 l ~ <br /> U.B.C. / 1 ]t e. (MWtl.. u,lr dwr FbAnrF nNY MIW. (wr W ro F 10,000 <br />TYPED OR PRINTED .ns ormvNN.n Npdoevwrr nre.n...nemmn..ve eY.va/ OFFICER OR AUTNORI2ED AOEFR CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA 110N5 lJTeterencs s6 ertecnmsnrs nets/ <br />.: i . ,. h; A L .. ) !.. ,. _ 5 I ` t ! `... I . ~ ~ = I . •'f ` , ' ~ : .. ~ - . L' ~ ' i 1.. ~ ' .. 1 .., r <br />r> .. L : ...1 .. L ' ' I .. i - . , T 1 t• T . t ~ ~ .. ~ . .. ..) ~ .. a -, _ " . , r r -. , <br />_ _ _ ~ <br />EP+C Foim 332D=1 OS= 1 Previous editions ~mey bs used. - REPLACES"EPA F 740 W CN MA 'NOT BE U E ~, / _ PAGE OF <br />