Laserfiche WebLink
PERMO7EE NAME/ADORESS (Include Farley Nmne/Lecerion ifDBnmq <br />NAME r v , sq q - v , - - . L <br />ADDRESS.'!."_ :?'> 1. ~ %. iC .+: •, "~;"7 ~ n'r <br />GLP.~'7n1 ••n R~IT;.T <br />FACILITY ~ - <br />LOCATION <br />~~. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR1 OMB No. 2040-0004 <br />fe.1s1 fn-tel ... ~. <br />°l'1 '??7T ~.1 '11C t (•;n-~ ~,,~ Approval expires OS31-9B <br />PERMIT NUMBER DISCHARGE NUMBER _ crr o•; rT^r <br />MONITORING PERIOD ~~ T ~ ' ~ • `""' n ., '" n c.,,. n ~~ { •- ~ c <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ ~! a TO ~,. ', t , ::~ ~: ^ n- qrq a o•t c ) 's;: •, <br />feo-zll fez-z3) fee-zs) feazrl fee-z91 (3x31) NOTE: Read Instructions bet co plating this Corm. <br /> (3 Card Ony) QUANTITY OR LOADING (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4B-53) 54-Bi) (3815) (4E53) (54-81 ~( OF TYPE <br />(3230 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />rszs~l ~-~/S <br />(sa-Ge) <br />88-70 <br />,..: ~~, ~; u .. -~. _ v : r • SAMPLE •, s ' ~" ` "^+' Ate,` r T <br />1) <br /> MEASUREMENT <br />' <br />' <br />~ <br />i II <br />f <br />~~ <br />1 <br />~ ~. <br />PERMIT:: t <br />I : ..rti <br />f <br />t. <br />~L`p~~~. <br />'fr fl/ <br />~ +: <br />~t=' <br />. r "L., ~ . ~)„ Y R r. U REQUIREMENT. - - - ,~~-~a-,-, #CFO .~ - ,.L~ :..r . ::~4 ~t1^'.~~fS- <br />" ... <br />~ 9kE ~~`. .~1)- rte + ~.,~_~ - <br />2:1 SAMPLE #O#SS~ aOPSS~t ;:vitl.,;,• ~ 1~) <br /> MEASUREMENT <br /> <br />iU4DU ) p p PERMIT tRID rtr¢# ~ "- ~=~ ~xr~ a~: ~' <br />,F~~LG°.k? ;77r5 V4 {,RF .AEOUIREMENT }:SRS <br />PF>klliilOtf ?~ '4? <br />KllLt~14 -' <br />Sri <br />=;,~' <br />.r1.t U~r lJ' SAMPLE •--•... ¢;.,. •,t r.F :k~~}:;'f: +; ~ TOE <br />~ Y E: N D ~ U <br />it MEASUREMENT <br /> <br />L <br />.. :+ ) J ~ l~ D <br /># <br />~ <br />~ <br />, ~~~ <br />1' <br />` <br />~.1~.. <br />-~~~.~~~ ggy~{ a~ <br />11.5 ~O~ l <br />~ ,yq ~{ <br />~¢ ;VA 3 ~- <br />- <br />~~~ <br />k Y <br />~; <br />S-, C0.•-1 :S P.NTS -'LJ pE <br />QI~ E .~_~:: r:.•`•~ ~'Q1`)]Y ~r~l~^+ ~1 i,T f.~ !SI[ <br />. '/r. tF tY11'j"l! " <br />_ '~ U'.r ~ U A SAMPLE ... S4S4 O :. ( 1 ~) <br />:i I) _~ P'_' Y U c D MEASUREMENT <br /> <br />U05SD 1 D D PERMIT ## , . +''' ~"~$ I5 ~?e' i4RPP.1: .R1(~1, <br />_F','LUENT GR045 ~ern~ REQUIREMENT _ {"=rt '. <br />+ ~03l1~A'•.C`` ~ttd~L7Ai! ^-'L ?h`JN4` . <br />~. l: ..i JS, S .7b .>, SAMPLE .740.'.!:.`• rte.: .. 'r.l±. .. r •r ~:~ <br /> MEASUREMENT <br /> <br />;; Ii„ 5 0 J ') .-.PERMIT'. <br />° OOR Z'~.`-G ,: #Ce6L#Q9t 1~~!13R4 ,r "? _;- ''~.~'' ~~r'f ~I R~) <br />4 <br />U?F COMriF.Vr ; ~ELJW A~OUIREMENT <br />-~. ,.. -_ ~".`z ~ ." .:~ - AY" ndr~ MI.-: hL/L . <br />'+5.,~_ ~,.. Tp . <br />" <br />., -...v U ~ y-:. r .°.1 ~ SAMPLE r:^::"Y: Sot?.?~ ?xOf.';'y ( ~S) <br /> MEASUREMENT <br /> <br />UOSLLS 1 D J PERMIT ¢- Ff+fOr ~t p n:~a ;. ,p4 *, ..-: ,1-flET" P±~R1'":. <br />~ <br />ItI~SE! <br />rA+l'~'. . <br />r.FFLU$NT ,. . "; Ve,L!1- REQUIREMENT ~ tt•"• ~ .3Q'D~'-. Af~ ffRiLf hY• "T,/L 17t)tiTy <br />1. G 6 t ~ .: ~' SAMPLE 5;::zd.- S'r4CY-: ttr:•.yt: ,;,~r,.x.. { ~ a~ <br /> MEASUREMENT <br />L .)`.s `~~t 1 (' 7 <br />- PERMIT at R}t#@I S '.; `-~'- C'JI'RaL4k 40:~L#kk t!} {: Q!~7 t.?I~ :'St!(E~'~'-' <br />'•FSI,7E"T '^- '~ ^•. - REQUIREMENT ~.bR IN,^° "lti7C ;/T 4gg~. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF <br />ILIAR WITF1 THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY <br />' TELEPHONE DATE <br /> <br />St' <br />ichard ~"Tile INQUIRY OF THOSE INDNIDUAL <br />THE INFORMATION <br />I BELIEV ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE S <br />T <br />. <br />i <br />~nvirorment~l IAanac er , <br />ACCURATE AND COMPLETE. <br />PENALTIEB FOR SUBMITTING UBMIT <br />ED INFORMATION IS TRUE, <br />I AM AWARE THAT THERE ARE SIGNIFICANT <br />FALSE INFORMATION <br />INCLUDING THE <br />/ ~~ ~ <br /> <br />970-870-7 <br />71 ~+/ <br />yl)~ <br /> , <br />POSSIBILffY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 41001 AND 33 U.B.C. <br />¢ 131 e <br />P <br />Xi <br />tl <br />M <br />I <br />l <br />i _ _ <br />SIGNATURE OF PRINCIPAL EXECUTIVE . <br />? <br /> <br />TYPED OR PRINTED . ( <br />ere <br />es un <br />er <br />esa statutes may <br />nc <br />ude n <br />nes up m 510,000 entl or <br />mex/mum/mpnsonment of beMSen6martns end5yeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />cumrvlL:rv I ~ Arvu rxrLArvA I lurv ur vwr vlvuaT lung (nererence an ertacnmems nere) <br />'.I,Td:,;1^,I', t.i"L'.. "` = 1TfLT'r•~LP 9)LL"'S (L l^ e~.) 1{nrT•v ~ .v T° ~- ,~_v"Ir ~q_gq .r~.t.T.. ,•p .. ,,, ., <br />„~,:"v„ i'.. __. ,. •-'~ 1 '~ F07 '.^o~c:9 lF P„"1j" a^'1nrnP .yT~. 'TIr - 'nre,-•__ ^c PO(lm qf•,°° p/ ~r <br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) ~ ^ t ~ T / o ~ ~ U l ^_, S ~ + PAGE OF <br />