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PERMRTEE NAME/ADDRESS ((k(ude Fac!(iry Nmne/Cacctian JDi$erent) <br />NAME ~YY';;' _'rt -ALT :. ~ 1".-. <br />ADDRGSSMIV•;''> l,~' '7DTv, '.'v"r I n~ <br />c N.: f. =:Y 13n ~ ~ 10]5 <br />FAaurY <br />LOCATION <br />r '!: "f7 ..r'i 4. ,r: [. d(i :?4i. A'~.4o <br />NATIONAL POLLUTANT DISCHARGE F1IMINATON SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR~ <br />(z-1B1 (n- a1 <br />'7~9z71.5q nna p <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM r •- ~ ~ TO ~''i ' <br />(40.211 (Z2-Y3/ (7aI5) (sb2]I (YB-28) (30.31) <br />Form Approved. <br />r ~ T ,rt ~ OMB No. 2040-0004 <br />(^ rl n n r V Approval expires 0531-98 <br />1 <br />eTuL• ) ~ r. .. t(rl r •r r. x•11.1 r•( ~ c]P <br />~NOTE: Read Instructions bet co leting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Cab Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (ae-53) (s1-s1) (3eds) a6-53) (s1-s1) EX OF TYPE <br />(3237) AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS (~ml ~~ 6e13 69-70 <br />L •iJY~ ."U:B SAMPLE ¢:; ;: r.,, ._ .~"F?..y h,..:...... ~ ~) <br />(,4.; Fol MEASUREMENT <br />i+~ <br />.. t 0 7 <br />PERMR <br />~,.r <br />#•1R1~. ## <br />7~'9 <br />9 . y <br />7. <br />NC{B '~ <br />pi <br />T.f:'i.7E!%T GR'lii 7', , <br />REQUIREMENT N, r,.'`•Cr ~ ~ <br />~OOA` <br />~wG , <br />~ r <br />•a~~~ rn7/L ~{ ~ c-, <br />. r - <br />.- <br />. + <br />" <br />P ;Ja. N C71~'1'IiT '7F SAMPLE ( 071 ~'•'`n4G •"'t 1k •"'r rxr.."`` <br />:'9.RL1 ?R?1T""Yf "'CANT MEASUREMENT <br />:0 )SU 1 i ) ~:: <br />[ti s,.,,,,g@~"R~' <br />~ <br />~ . YORE' <br /> <br />' (~:: <br /> <br />K' T ###4+9F0 r <br />, - <br />~" ~~x ~ O . <br /> <br />~ ,+.~t <br /> <br />~- ~+[ <br /> <br />~ <br />~ <br />PLUEN? GP'` T Vrt LOR e <br />E~b <br />REM NT <br />" ~ ,~Y($~ <br />$$D 'j, ~ inn " ~ ~ <br />u ~ `i~ SAMPLE ... .. ( 94) .. .•~2r. :^.aa,. <br />`. ~t.^.t^:•~ <br />s f 313 A L MEASUREMENT <br />.!1066 1 0 ~Oy `~r"PERMIT - ',: 0 `•~=1 ".)IR~'•K #>C`'?~##+R Ct91#$#tR" R'kM ~i FC'~~r! 51~ <br />OENT GRq~ V1'. !tF <br />°'FFI REQUIREMENT , <br />M <br />• <br />~ Il1a! E(1-Z NO=O t~: - t fy <br />::-k' - <br />. , <br />n . <br /> SAMPLE <br /> MEA <br />SUREMENT <br /> S <br />~~~.4 ~ r~ i. . `&T..4i ~h <br />~C• • r <br /> RE "I ENT . ~~,~: " <br /> SAMPLE <br /> MEASUREMENT <br /> .." PERMIT <br />- - <br />~ - <br />- <br /> REQUIREMENT - ~ ~4 <br />" ~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT <br />" ~ ~ .. ... ~ (o- <br /> REQUIREMENT ". ~;."" ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT-, - - ~ .~-"~ <br /> REQUIREMENT " <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMrTTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MY <br />' TELEPHONE DATE <br />°.ichard Mllls INOUIRYOFTHOSEINDIVIDUAI <br />THE INFORMATION <br />I BELIEV SIMMEDIATELYRESPON <br />E THE SUBMITTED IN SIBLEFOROBTAINING <br />FORMATION IS TRUE <br /> <br />Environmental I'3nr'.ger , <br />ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTN <br />I AM AWARE THAT TH <br />G FALSE INFORMATIO , <br />ERE ARE SIGNIFlCANT <br />N <br />INCLUDING THE <br />~ <br />9]Q-Fj70-271 <br /> <br />POSSIBILm OF FINE AND IMPRI <br />4 1319 <br />P <br />la <br />tl <br />M <br />, <br />SONMENT. SEE 18 U.S.C. 4 toot AND 33 U.S.C. <br />/ <br />l <br />tl <br />a <br />b f10 <br />(xx7 <br />tl <br />SIGNATURE OF PRINCIPAL EXECUTIVE / <br /> <br />TYPED OR PRINTED w un <br />nc <br />. ( <br />erb <br />w <br />esa stables rrey <br />u <br />e <br />rrea up <br />, <br />en <br />d <br />maximum impnsmment ol5etwsenBmonMS entl5ye9rs.) OFFICER OR AIITHORRED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all ettachmenLS here) <br />r.Lf;"t :YA?r: LT`!iTr; crTp •ie T474 : 4'TL: q-iL': $7T rrj ((•T- ~n~) Y~oTT rr ~~•tiv r'v ;= t!t_vv ~r1_pn oq••••r~i ~rrrr .~ <br />"i CLd CMP.D. :!]= ~.1 ~7 ?, 19 F?F 17AD'4 ^i. r~v•.m-, <br />r • 7r" 2R'1 (7f R IT4 7 a[[ ^7~•R ~v~r; rr^ rll rlTN nrq• ~.~~ ~. <br />~norv .'a ~nnr f~f- or .nr ~-- ~.r• ..n ~.. .. <br />EPA Form 3320.1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,t n T v ,) ~ „ i ^ ry 1 ^_) S ~ II PAGE OF <br />