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PERMITTEE NAME/ADDRESS (Include Facitlry Name/Locarion iJDi$errnd <br />NAME n.°A~ ... ~ ~ _- . r <br />ADDFIE$'S"9I:~l.'.r1, „a -.`,TI.•`-~.~ .. I.^ •.~v .,z <br />FACILITY <br />LOCATION <br />'iTN: laPItN7~ d~.:1,°vr ^•r'.FlIL hT'i? <br />NATIONAL POLLUTArfT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 <br />(4461 (f ]~ 9) •I ! T 1 ^ <br />7 0 7 2 71 S!t ~ ~ a 1 (~ rr o ~ ,: u 1 Approval e>~ires OS-31-98 <br />PERMIT NUMBER DISCHARGE NUMBER c _ c... R) ~ ~'t ^ ^ <br />+, "; ~ +~.,un a m rnr ! <br />MONITORING PERIOD ) • ~ ~ n ~' •~ ' <br />YEAR MO DAY YEAR MO DAY <br />FROM r TO ~' ' .~`k v. nr c•~v .I., ..~ __1 ,. ^: ;I <br />lzazr) Rz-z31 (zazs/ (ze-z]! (ze-ze! l3oaf/ A NO7E: Read InsVUCtlons before completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION N0. 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C' .SD D P ) ~-~PERMIi ~- ~'r~'?%i ttR+%dl~7r- " r..S:~ .. +O+R# N'$'~G$~",' <br />` RF, P~lr, - ;: ~ P.~$~~( RiC.~+~ <br />_ COI[l4E~TS BP.LOY C REQUIREMENT- ,.'~^ '.:?C.t ~ , _ <br />•J0011 $) Dllltlf . ^':Ir ~- 4 '' <br />iU:.I :)5, TOTAL SAMPLE #II##R# .#>"< #it^,-.•- ( T.T! <br />` <br />.~ S S C h' D MEASUREMENT /~ ~ /I <br />, <br />I) 5 3 e 1 D o pp= <br />r1 Y. ~'4 <br />'' prat#ai i a <br />,'i <br />vY1 ~ `•~ * <br />~ ~#sa#9c <br />~ <br />~ y <br />1 nn <br />~L <br />$~' {{ yj <br />~. <br />~ <br />`.~I'LUY.RT GR7S~ V9LU +AE~ <br />UIF1~ y <br />r+';•. <br />. <br />a <br />A ~... <br />- <br />~"~. <br />:. <br />~ ~).^.. n~IL2 llllf ""/i, i <br />e~ = ~ <br />lIOX AT <br />~ULi rr S T°•L"'.;L° SAMPLE ~`7:Sx¢#!Y V~ <br /># <br />•` wn.r..~,. ` ,51 <br /> MEASUREMENT ~ ~ N <br />)'~ ~~ N <br /> , N f1 <br />7JS45 0 7 ? <br />3 <br />' PERMIT KIIi <br />~'~~` "` #Iriiii 9 #Y# al ace: <br />.. <br />~ RP.P©RT'` <br />- r~';' <br />` .- ~ RP,P/4 R(l~ °j <br />i: r: CD11tl ENT5 B <br />t: 0~. REQUIREMENT ,: ,: 43## , ,~,/ <br />~(7 U7, S LC11'L" SAMPLE IIt•II#GR rtnt #ryC±r. >t r ~~~ l <br />/ <br /> MEASUREMENT I 0 J7 <br />~~5 1 0 0 PERMI~ ', +~Ci #- O r~kr ~:#II ~~ ~~ '~ : Rt? tf~t T BR$L*~t ~~~ <br />` ~ <br />c <br />,r <br />rLOENT GR7.,5 V1L'1. <br />REQUIREMENT <br />.T <br />~ - <br />'=#t'.= <br />~(~'~~ ~I;:: <br />(1ACL*" rX <br />'!/! <br />!( ~, <br />_ <br />s <br />./1L V 5? SAMPLE -~rxaa rx~ <br />L^ _ <br />v... .... <br />Ate; ,.. r.dtS:~ <br />~} ( ' ~) . <br /> MEASUREMENT N ~~ <br />uU555 1. 0 ~ <br />- <br />' PERMIT #Alipl## 'lrprii§ri. i II+k~ ###7k+r!X iAri4II# I1 ' C 3!trlat. $$~' ~` <br />°! <br />Lp${(T G'•'0i5 V^.!''~ REQUIREMENT v.^S:? ~ I!!ST :'1 ~"71. .; .~ T +~m <br />NAME/i1TlE PRINCIPAL IXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF l <br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN <br />AND <br />- TELEPHONE DATE <br /> INO <br />RV OF TH : <br />B]SED ON MY ~, <br /> <br />Richard I!~I))S UI <br />OSE INDIVIDUAL <br />THE INFORMATION, I BELIEVE S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE SDBMITTED INFORMATION IS TRUE, <br />_ /. <br />~ <br />^' <br /> <br />ar <br />Enviro <br />ntal ~vtana ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMTTNG I AM AWARE THAT THERE ARE SIGNIFlCANf <br />FALSE INFORMA710N <br />INCLUDING THE ~ <br />/ <br />/~j{,P <br />97D-97D <br />2712 v a~ 99 <br />g <br />nme POS <br />IBILITY OF FINE AN , - D <br /> D IMPRI <br />S SONMENT. SEE 1e U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> ro end soda fiires uprotr0.ooo andw <br />m <br />m <br />m~ <br />~ <br />~ <br />e~o <br />e <br />n e~ <br />~ <br />TYPED OR PRINTED u <br />l <br />m <br />l <br />s <br />M <br />e <br />m <br />onr <br />Yae/sJ GFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />l.V M1YICIY 1 J /VYU LAf'IJYW^ I IVIY Vr IYY 1 YIV V\I IVIYJ (ntlltl/tlrl4tl fLI tl11L4lrllltlrnJ /IfIIFJ! <br />~Li "ITN 3T~ LI'1ITS PO° ..,i; `; .dT~f.°t°L S~1.TDS (T.')C ~7'I },^nLv 'IHI~ I° :- ll-°^r ~R_v4 :`a~~CTn vV rv- I` <br />~L?IS.4'.D. ~';~' T.'..?, -' ].'ir °'^R ,)11R)gG 7F PR7?.° ol:_i11T4°~°@mS. ')rr c <br />r <br />EPA Form 332O-1 (085) Previous editions may not be used. (REPLACES EPA FORM Td0 WHICH MAY NO7 BE USED.) 0 ~ ~ n S / 7 T n H T O_ T [ ~ n PAGE OF <br />