|
PERMITTEE NAME/ADDRESS (lnctrdt Fadliry NmndLrkNion I(Digemnq
<br />NAME
<br />ADDRESS r l n ': t .. 1 ~ 11. -,
<br />. -.-II
<br />"i Ki., ~
<br />FACILITY ~ `~
<br />LOCATION
<br />NATIONAL POLLIJrANT DISCHARGE ELIMINATON SYSTEM (NPDES) Form ApprOVed.
<br />DISCHARGE MONITORING REPORT IDMR) I t 4 OMB No. 2040-0004
<br />r '.
<br />PERMIT NUMBER DISCHARGE NUMBER ( _ , ~ , .
<br />MONITORING PERIOD ~ j---•~ ~~`~ ~ ~ i.~ ~ ': L. ;.ter
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ' ,; TO ., •.Ir ~'J ~ :r i ~; ~,.. 1,_,.. ;•:::.;
<br />NOTE: Reed Instructions before ompleting Mir form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br /> EX OF TYPE
<br />PARAMETER
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rWaLti51S
<br />
<br />r SAMPLE ..:..... •a ;:
<br />~ .. .... ;-:: `.~:.: ,, ......_.. ( L')
<br /> MEASUREMENT
<br />1 . • , 1 i •-''PB ~ 3'f_ :#4p
<br />' .. ~. '.~
<br />jjj ~ ~ ~a ~ ~ C Z}~~;~'Kt~ c
<br />~ ~' ~~.~LY NS~'C].
<br />
<br />t ,I ~ 1
<br />1 y~(~~
<br />REV14 N :f
<br />~{X
<br />~
<br />j~Y f
<br />^•" xY4 ~ yyy
<br />i
<br />§~~
<br />tw
<br />L~ j~
<br />'
<br />~ > .
<br />~"
<br />.
<br />. , b o, .
<br />L
<br />. .., .
<br />- (
<br />i 1'
<br />n
<br />x
<br />' eP
<br />~ V J
<br />
<br />-
<br />;il.fi ;, r!~.At. SAMPLE ... :;.7 ~zr ,. .r:;.~.; ,._
<br />• ~ .~ :' ; 'i : ~ 1 MEASUREMENT
<br />
<br />"t :1- f G'.G~;; YALI~ AE ~ a ~"~ •~ '~ 3 M 't{Yi "A yr
<br />"'t..f.., Si: `TL?A9L:: SAMPLE ~ .,,.•~:~z :r;- .. a~z.. ~ ( ~;)
<br /> MEASUREMENT
<br />D 1~' ~~,
<br />'~ _g ~M1y .,
<br />
<br />,,
<br />,
<br />: ~. ~
<br />
<br />~
<br />
<br />'=?
<br />d
<br />-C i;..JS , 'V.ALi~ - MINT
<br />E4UI~E ~
<br />". _
<br />.~ s r .,,~
<br />..
<br />- ~
<br />a`r:
<br />F A9G-. ~ ~ ~- nL/i .
<br />-
<br />_, _Jf 4L
<br />• SAMPLE r:.:~z:.
<br />; :/ ~: Kt ( L-.,)
<br />(A', .:) MEASUREMENT .'}{" i
<br /> p ~ ~
<br />~Fi'L!I:.+T G~ J~ V4LU H~t{IHEt~ENf n
<br />:. `'' '7~ ~n~ tfTi AY .,~: „
<br />iii. AtiU .:nF.n`rE SAMPLE .. ee r:4 it r:
<br />5 g-O+zez:'s ~~ ( ly)
<br /> MEASUREMENT )
<br />Ui`r!+1 1 J U arz` ~n~~ .
<br />e: }'FLU ENT GRU55 YALU ac>ta }' ~=~~~- hi;
<br />}'L:)Ha Ifl C7`+DUI'f OH SAMPLE ~ ) n`r'+:~``'I' ^+R;`C x4 f=>t *tf K:':
<br />1'NNU T't.4 P"F.NT PLA;+ MEASUREMENT ~ j
<br />il1U5J I J U ":.
<br />~
<br />~F
<br />~
<br />~
<br />+"
<br />•ICS'~A
<br />
<br />c}FLUENT :F.:~3 ~ 'JALU' e n
<br />`~ x ..L
<br />t .~
<br />1G~ _
<br />3'k3
<br />~~'.` ~ t .. N
<br />:~4~„`
<br />~ ~ :
<br />Kr,
<br />.
<br />
<br />,
<br />;JLID$, I9TnL SAMPLE ^.~:r:... .-rv{-.~.. ti:~V{:^:i: ( i:))
<br />:; L i; 5~ L Y `: R MEASUREMENT
<br />
<br />nm tE~
<br />,
<br />i, r' }' L U t. ~. t G r{ :~ . V A L U 't~~{~~CiENt€f3T u . ,
<br />~ rx. ;t;..t p' ^ z ': a $V3'R° A x ~,"
<br />NAMEli1TLE PRINCIPAL EXECUTIVE OFFICER ICendy antler panelry of law that this tlocument and ell agaehmarae were
<br />i
<br />i
<br />i
<br />I
<br />d
<br />h
<br />d TELEPHONE DATE
<br /> on
<br />n accor
<br />ance wn
<br />a system
<br />es
<br />gned
<br />prepared antler my tl
<br />retiion or supervis
<br />P
<br />t to assure Net qualllled pexnneJ properly gather and eveluaze the lnlonnallon / /~ ``/
<br />'~
<br />9 ~ U-°Z 4 "~ v 4 U)
<br />U i
<br />07
<br />2 S
<br />e
<br />ers
<br />W. Cordon submlped. Barad an my Inquiry gl the person or persona who manage the system, G...,/ C ~vn.
<br /> responsible br gethatlng Uta imoimsllon
<br />the lnlarrretion
<br />wthme persona tllrecll
<br />President/Genersl Manager ,
<br />y
<br /> submitted Is, ro the best of my knowledge end belief, true, accurate, and complete.
<br />r
<br />i
<br />I
<br />i gIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED icam penalbea fw subm
<br />tting lake
<br />nrormal
<br />on,
<br />t em aware that there em signi
<br />Including the nossiblliN Olfne end imorlwnmeM br knowing violations. OFFICER OR AUTHORIZED AGENT
<br />_ _
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here)
<br />.~ '',TAL I'i'.~,Y i.IAi:~ .:iLL '.IV F:, :v :,. .. :C:f, t' L,. ~~LIi J ...".i" ,.. .._ a ~ ~ ~ ~:. ..":~l :!_
<br />ct+ sl ll~,.p 7P i'9ii0F .. '; ~'If; F:;.:r.?_ :Li? i. ~. i. TI;S 5J4IT;i lilt. .> 1. ._. .. . _. . . (~~)
<br />Ep%1 Form 9320.1 /99) Previous a Itlons may be used. ~~ ~ _ ~ ~ ~ ~ ~ ~ ~ ~ ,.. ., , T}IIS IS A 4-PART FORM PAGE I OF
<br />r
<br />i
<br />
|