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 />
|