|
- - -' w . ~~
<br />
<br />PERMITTEE NAME/ADDRESS (/ Lb f•c,AryNaWla•nm 1/Dl~r."q - - .. _.~_.~-~.
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM (NPDESI -.. c
<br />FOrm ApprOYed.
<br />NAME ~ Y ,~ ;• -~ , -. { + ~ ' ~ - • -~ ~ A L -_ , r -.
<br />' DISCHARGE MONITORING REPORT lDMR1
<br />r3as1 n7-I91
<br />D~ F1 n r ,1.
<br />~ * v F 1
<br />,toIdB,No:IZOao-oooa.. ;
<br />ADDRESS ~ 1 V r 'i 1 • ~'
<br />- - '- ~" ~ j =' /
<br />E °R"IP 't ~
<br />':,0 27154 n a
<br />~, t •
<br />r,-,.:~ ~'/~ ADProvel egPges05-31-SB
<br />
<br />:~ 1 U It 1 i"
<br />T: T" ~~ j C~ N^ i >:
<br />PERMIT NUMBER
<br />DISDNMDE NVMBEII
<br />r c T ~ ~- +
<br />H'~Lr . J.i ^,n '!'JI 77 q. Tnn
<br />FacIL/TY MONITORING PERIOD
<br /> YEAR MO DAY YEAR MO DAV
<br />LOCATION
<br />FROM
<br />''Y
<br />•.
<br />TO v~r
<br />rl
<br />,.^..; .:, n'grv qo^~• `.
<br />~~~ '":iv
<br />'_ T T ; : '^ ~ 1 ~' k'_ ~- ~ - ' ~ !, ' ? r ~ ~ 1~ . r• ~l (. 7 ~ Y Y !26711 l77-731 134751 !76771 118-T91 1303/1 NOTE: Raed InetruetioDe 6afor e completing this form.
<br />PARAMETER 13 Card Onlrl QUANTITY OR LOADING !t Grd On1Y1 QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> 146-531 !54611 138-~51 M653 !56611 OF
<br />133-J71 EX
<br />ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (e7-e.T, (5a-eBl !69.701
<br />, i SAMPLE .f..-.... CL-fi'kfi... _; ...c .; a;.. ( ? ~)
<br /> MEASUREMENT
<br />;/u~'.~~J 1 v PERMIT ^~'."'X~:;4 ;:trrirG:. r :~,:. 5., -to-two /,ry ;,«.KLY ~°AP
<br />.
<br />^'*-L'J e: '~;" ,5^.:"~ '". L!)c REQUIREMENT 'f vYR `tL NIl111'" kg~Tkt,r et ;r1
<br />5r'?,I pyF i'JTPL SAMPLE t~~k (:."-h: r,; t, ..'F ::fi 4.¢f,;;r•; ±e ( t.i)
<br />U .i P t h C ~ MEASUREMENT
<br />i JL.JG . f' ~ PERMIT 3#'RC#.f '+SY aI #.9±?? Gt.`: ~ S+R44:•! RF Y7 RT RF: POflr~ ~ t NC°/ :°AP.
<br />~:'_ CO':N.aRT~ ';"r,~i' .REQUIREMENT :y:^:-..- TDP[~. ~Y'; !?gILY !S 1C Mr/L 1108TH
<br />'uLL04, lOTll i. SAMPLE ,; r.fi;: r, aafi.~?: +r {: •••:A•: •: ( tr))
<br />d S Y E H Il E D MEASUREMENT
<br />JO`.311 1 U PERMIT 'e •"te °. 'X'; fist#',:$-~:
<br />
<br />- ,r ,, :~{r }., leA T5 70 ~n
<br />>,.E'/
<br />'Rlla
<br />~, ~F'LOEHT GR7`: _i JE j, `+~ REQUIREMENT Y,:-t}4 '37'.p qqr !'>4T Ii '"1( k3/L MOFT`T
<br />..-igt,I OS, SF.TTL ~ ~:'! ' SAMPLE r{ci-S: r4'::F'fi .-.. ~ ~5)
<br /> MEASUREMENT
<br />J'~:;'15 7 0 PERMIT rC•C:Y '%+r4 :": '.:rc R'.+#fF^+S R'P'S T'T ^•5 ~?!~f/ ~L'An
<br />. C0.7'",?NTS '-~L.lc REQUIREMENT ^~:~fi T!?7F; Pqr, PSI L° !';( NL/?. `t0!`"'i
<br />~:;LIDS~ :iETT`., i, SAMPLE .v:r;:G, .:r:Y,:^: ~.".: r:vY ~ ?c)
<br /> MEASUREMENT
<br />Ij~-. ~_5 i f! PERMIT 3YA tr?fi ,-.:-fir. -'~- ,. S!: ititd; t5 pF ~1 ~v' }tF ~'r1 Grn ~./
<br />I'I C ..~~,
<br />L U_°'I ;' ~ R U "> ~ ~r a L^ ~' .REQUIREMENT ry ztX fi r~
<br />3t70A 114.
<br />D=1IlY MX
<br />~i./L
<br />"':+'.':+
<br />_ 0.;:'J '=Ei~;?` SAMPLE :k:: R.,.;l.:: fi".FRF 4+:Y `.: Yihr•n Y: ..",;fir': ~ 1~)
<br />~Z.:7N ~•XTR-:'1 f,V "'-'~. MEASUREMENT
<br />.ti -,56 1 r? PERMIT fi.~:C:;--fi '##$fi~' .'A ~'~ 3fA x:#tk;: °f,~#t`#i4 1C ' .?j `ITI~ '!?A ~l
<br />"!"LUi?l? .~' )S`0 •'T,'I'= REQUIREMENT fi^.-.rt
<br />J. • -'1"°.. SAMPLE , i:nx^ ~, Y:: yYC x-~~YA.; ~, ~ T ~)
<br />
<br />" )
<br />-..i
<br />MEASUREMENT
<br />IT ;try L' (.~ i PERMIT ,- ?rt ~~:Y RC-:'::x#=t : ;s ~:~ :~kY: r-::; ^o n•• c
<br />S :i'. ~C~, .. ..'. •'° T~r,JY REQUIREMENT fi..~y .T~C+A 9'7.t; RnTLY "a .,._/1- q et c
<br />' J T`
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EIlAMINED AND
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MO BASED ON TELEPHONE DATE
<br /> MY INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR /~
<br />
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~
<br />/
<br />~
<br />ichl3rd ..,ilia TRVE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME ~
<br />//
<br /> SIONIFICMT PENALTIES FOR SUBMITTING FILLSE INFORMATION
<br />INCLUDING ,
<br />`%
<br />r _
<br />Cll VirOI1T'!•'_,l t:~l i daBC!?I ,
<br />THE POSSIBNTY OF FINE MDIMPNSONMENT. SEE IB U.S.C.f 1001 MD37 °
<br />BIONANRE OF PRINCIPAL EXECUTNE U70 S7Q-2]1Z 7 ^f5 94
<br /> V.S.C. f 1 ]1B. (Mr,rM• UNr Mw mnrw• nur NrcA,d• fws W ro f 10,000 AREA
<br />TYPED OR PRINTED marnmubrun brArianlnr•Ibnrw emonN••MavANa/ OFFICER OR AUTHORRED AGENT CODE NUMBER YEAR MO OAY
<br />COMMtrv IS ANU pAYLANNIIUrv VF ArvT VIVLMIIVrvD fMe/BrenCB a//eReC/IIDBntS OB/el
<br />L",°38AT=: Liyl..; roe *;,F 1'+?',
<br />~J ~': ..I I/~ 14E
<br />
<br />' ")/ Y LI4D` J' DC Cr\D TT p^ TvC ~ 5 "T;e^.'IL° •ILTn` (L.J': "+t) ~^^1.Y ~~'7.Y
<br />F, .ni' ~i~~; r'''. ti' 7C PO:JI'~' J'a "'tTT • ,"Tr C
<br />
<br />TD'I^nTnN'C-a-i -,wv 1wC n/ 1- '_ f'-9'., ~!:-"
<br />r•p'!~-'~'+•'CC P('l l~"a'l ~t" '_+°^i: •. .,
<br />F/ 1
<br />•
<br />EPA Form 3320-1 108.95) Previous edluone mey be uesd. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 PAGE OF
<br />
|