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PERMITTEE NAME/ADDRES$ ((r¢(ude Foc!(iry Nmne2ocanon ifDi$erenq <br />NAME CY PH[:S Yew^A VAL!~-" "~aJ. ^ORr'• <br />AD~S~SiLYG'".i Lr ~'.j C ln^'Rr c^P'laR Dk <br />FACILITY <br />LOCATION <br />.. '4 ~;T ic4L '''. r :T 1'v1 '~;V~.~71. aTU' <br />NATIONAL POLLUTAM DISCHARGE EIJMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR~ <br />t~~1e~ n)- sl <br />_7~'12715R ~0'. A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM " =' " ( ~ ' TO ~ ' - <br />(z621) (zz-zJ) p4-z5) (zF2)) (zB-z9) (36311 <br />Form Approved. <br />„ ~ T „ ,. OMB No. 2040-0004 <br />(C n ~ n ; , • ~ Approval expires 0531-88 <br />.. _ .- . a r T. n l n m ,. <br />\ --/ <br />NOTE: Read Instructions before completing this tone. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Cold Ony) QUANTITY OR CONCENTRATION NO. F OUENC SAMPLE <br />PARAMETER (4653) 54-61 (38-a5) 46-53) 54-61) EX OF TYPE <br />(32Jn AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ <br />g1S 70 <br />69 <br /> ~~) ( <br />84.6 - <br />i . ~ V C r 1" SAMPLE .=:~:.v :: s ~ z , F .. _ R.;.... ,... <br />t r, <br />( ) <br />(a . F 4` I MEASUREMENT <br />1 <br />5 <br />L !! ~ .PERMIT: ...k ~ ,~~~~, ~~ S 7. Q ~- ~ <br />~r <br />1 <br />•I I ~ +~_ <br /> ... <br />•~ .:Y4 . '_~IJ'. ^ SAMPLE ( U3) .... r---r <br />~ ~ ..-. .•~p:x. .fiA~x.y <br />:R9U i^a:{TY~.Vr "L}" MEASUREMENT <br /> <br />~71iS0 L 7 ) PERMIT; -- <br />- ~. ~ - l~*~ <br />' 4 'BOA'. R ~~~~~l Y/I,*~" ' +~.~~~'`~ '-•''~ <br />~~ ~~~~ ~ <br />•rtt,JF:NT _,^7 ;ti YPLr'` AEOUIREMENT ~QLI~ ~~'+&' ~ RR~LC• ~ !!I;1? ~ -"W" "-2:.. -'; • - <br />s.K>;- <br />~ ~ u ... SAMPLE ..: y) ... r. st^nt~ r..-l _.. <br />I S U A L <br />' MEASUREMENT <br /><Y <br />1hb 1 0 n MIT ~~ =rzi . - a.°-1 ', ~4' +Rxa4 Ila~lF -Yt €~ <br />y 4:1~iCT,E 't <br />""LUF.9'! G?^ ~ 9aLUi , II EMENT - ~'~~d I:O='r a •,;: <br />? '~" <br /> SAMPLE <br /> MEASUREMENT <br />~, ~~, <br />'' REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT +. , ,. + •"'' .. <br /> REQUIREMENT a~,;!'~,~ - r t ,; .l <br /> _ <br /> SAMPLE <br /> MEASUREMENT <br /> ,PERMIT- ',"" - <br /> 'AEOUIREMENT ~ - - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL IXECUTNE OFFICER I CERTIFY UNDER PENALTY OF l <br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMRTED HEREIN <br />AND BASED ON MV TELEPHONE DATE <br /> ; ~ <br />' <br />Fticharc' ~t4tils <br />s f <br />r <br />l <br />t <br />~ <br />i INQUIRY OF THOSE INDNIDUAL <br />THE INFORMATION, I BELIEV <br />ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTING S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMnTEO INFORMATION IS TRUE, <br />1 AM AWARE THAT THERE ARE SIGNIFICAM <br />FALSE INFORMATION <br />INCLUDING THE <br />~1 <br /> <br />7O-Q7O-2712 a7 9~ <br />a <br />_lana~e <br />nv <br />ror.~en POSSIBILITY OF FlNE AND IMPRI , <br />SONMENT <br />SEE <br />8 U <br />S <br />AND _ U <br /> . <br />1 <br />. <br />.C. 41001 <br />33 U.S.C. <br />li SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED tres up trt f10,000 erM a <br />nlrulmumlionmetrt old yen 6nwnMSrend SUdB <br />Pn r~~l OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMENT$ AND EXPLANA 1 TUN UY AN7 V I V LA I I V NS (HaIB/enCe 8118naCnmeD6 DBIBJ <br />... r'. Nt1 C' LT"T•'S - '."iS1 1'.; :)~ .. ~='r J'LF. 11 ':, i'rLTJ~_~ (Ll' r^~) 3, '•nIV ~uTv - ~r_o-.~ ip_q-, r•q~ ^T.~. .y ~~.m <br />_'i iL. /'Z'n ~.: ... ~''. i. i1. 'I ~ 11{~ °O'7 iJRDFy ~r pa7pc us•1•rT-(or PY, '^r. lT~ r - •,}^~_~c•. an ~~-V.~Tr v/ ~. <br />~.!'.1 Y- c,1 pr T." ^!"' ^r•. .Y: }^n^w r'IOC.P71TV n4P n/ I <br />EPA Form 3320.7 (OB-95) Previous editlons may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,t ~ ~ ~ n / ~ T n ,! 1 ~ _ s ~ ~ ~ PAGE ~ OF <br />