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PERMITTEE NAME/ADDRESS (Inchde Fadllry NmnrJlamNon IjDipemQ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ FOrm ApprOVed. <br />NAME r • ~ rr ~ _ DISCNARGE MONITORING REPORT (OMRJ OMB No. 2040-0004 <br />ADDRESSI`Ai Yr. ,1 ~^. l'•t 'i~~~ t~ -fit (~I':. ., aw] <br />,~ , 7 , •. ~7;: i ~. 7 r PERMIT NUMBER DISCNARGE NUMBER _ ;. 1. <br />- 1. '. <br />- A i ;, .- :. 1 i 7'• MONITORING PERIOD -- `~ A ~~ `-• ? ~~ '~~ ~'-'f ? ~ -~ U 1."N <br />FACILITY ~ ~ ` <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM .. ~; II TO U1 ='' ~~ `, :i _~• ;C~'A'., `, ~ ~ `.'•~ <br />,- <br />- r • , ~ ;~ •; I' _ ~~ ~ .- ; ~ r c m _, ~ - s.• •, <br />NOTE: Read Instructions befor completing this Torm. <br /> QUANTITY OR LOADING GUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX of TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~^I-ysts <br /> SAMPLE ..r .... • .: -c < .. ~ ( ~ , <br /> MEASUREMENT <br />... 1 ~ ~ ~'~. - ~ ~~.. <br />° ' d~ Ja `~ a <br /> , <br />~. ... ,, '•UP;!. SAMPLE .. .... a~-. .. r,<r,..r.¢,... ( ) <br />. _ % ~.i MEASUREMENT <br />~, i J 1 J •kG e} <br />~~ ~ W <br />I. .:. ta < <br />._r-'_:, :;L•'_'TLEA:,LC SAMPLE ':«aaod ;--~rstr,:t= ...._._ ( - I <br /> ME <br />ASUREMENT ~ % <br /> y <br />~ y <br />,~ yf <br />y <br />- ~[~~rvrv <br /> ~~ ~ <br />' x~ ~ <br />z, <br />`r L <br />`• <br />,, . "•'t A;. SAMPLE - -~.• rr.: r- d O'.~Sk Sir ( <br />ly~ <br />I n • ~ MEASUREMENT ~ <br /> ` T $~1~• <br />I. <br />r ' i ,,, )' : ~_ ;l <br />~~ EfJ1EflT <br />a~- <br />N <br />. <br />,,. la-. :;ht:4'~ .SAMPLE .:'k3a:: ._ O ..,.... Ot~kS:k:k::: ( 19) <br /> MEASUREMENT <br />/ <br />1 U U 7 +" ak, K ~$ <br /> $° , <br />- <br />. <br />J~, ~~: C.7NJUI'f Orl SAMPLE / ( 03) ~C:~4sr r:Gr.~;<~t :k q/fsark <br />,... i^. ,.dT"c"fT Pl,ip MEASUREMENT <br /> , t r fil'3TA ~ <br />•- <br /> <br />.v P GirJo.~ YdLU <br /> <br />:. .. <br /> <br />~ ~ <br />. <br />' <br /> <br />.. ,;U <br /> <br /><. t ~~, ,, <br /> <br />at .:. <br />*. <br /> <br />•t, w.. <br /> <br />~ <br />" <br />J L I ~: i; , : ') f D. L SAMPLE ^x :: ~ 9 :k r g r ?: r r.,;:.. ( 1 ..~ <br />~ r ~:; ~ (• y ~ ~~ MEASUREMENT <br />/ .I 1 ~ l' ,': ~ <br />~ <br />~ .k :r t. <br />~?; <br />* <br />a.a ~$~ <br />~. <br />~~ <br />t~I:~` <br />~A~ <br />!M'h"., i•:r l' G''1J` VnLI'i pEC} <br />UI~IEMENi •'~ <br />~ s' Opt; ' <br />- ;x rr rj; ' ~ <br />4 . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER (Certify untler parWry of law that Mis tlowment entl all attaehmemis were <br />r <br />tli <br />r <br />vriN a s <br />stem tlasi <br />netl <br />tl <br />tl <br />ti <br />i <br />i <br />i <br />tl TELEPHONE DATE <br />g <br />prepare <br />un <br />a <br />my <br />rec <br />on o <br />superv <br />s <br />on <br />n acmr <br />ence <br />y <br />to assure Met qualifietl pereonnel properly gather antl evaluate the inbrmation <br />itted <br />aesetlonm <br />ir <br />ul <br />orthe <br />ereonor <br />r <br />wlwmere <br />eMes <br />slam <br />W <br />Gordon Peters <br />b ~ / /f ~/ ~- <br />C L / <br />~K <br />y <br />p <br />ry <br />p <br />pe <br />g <br />y <br />, <br />, <br />su <br />m <br />. <br />sorls <br />or MOSe persona tllrecUy responsible br geMedng MB lMormatlon <br />Meinronnellon ~ g7r,-_AI/.-.44U1 O1 07 ZS <br />, <br />President/General Marla er <br />l <br />ecourate <br />and com <br />te <br />g <br />N <br />tl l <br />t <br />M <br />b <br />rd <br />k <br />tl <br />d bNi <br />l <br />l <br />b <br />p <br />. <br />m <br />e <br />e , <br />o <br />e <br />ea <br />my <br />now <br />e <br />ge en <br />, tme, <br />, <br />e <br />su <br />e <br />false Inb <br />1 <br />Mm M <br />l <br />Hi <br />t <br />W <br />ti <br />b <br />b <br />tt <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br />am aware <br />ere are s <br />gn <br />can <br />pena <br />es <br />r su <br />ng <br />mre <br />on, <br />m <br />t <br />TYPED OR PRINTED intlutlin Ma ssibili of fne and im dsonment br krwwi violatloru. OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GOMMtN 15 ANU tnrlarvA I I V rv V r ANT V I V LA I IV NS (tterBrenCe all aRBCOmenrS net) <br />.i t; ; 7' A. L I k .. L I °, .. ; ; ell:. .. - .. _. , ° ~ T '. .. .. ." . 1. '' r.. .. '. ' - , V J ., t - <br />, ',iIHL,E' 3r' °5.~:;Y !'`.~ib~ .,;~!, ~ ° I.. .3. ,^ll_> :"):JI::J"ING - '.I... ~. - .. l:l. <br />IfA Forrh 332b•1 ~(R 9) rewou e' I ons may e u ed. ~ " ~ ' THIS IS A 4PART FORM PAGE OF <br />,~ <br />