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PERMRTEE NAME/ADDRESS pnclude Fariliry Nmne/Locarion iJDifferent) <br />NAME ., r • ' _ _ . .i _ , I . -. ' <br />::~'.L~.: ~^r °7155 <br />FACILITY r <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />"70'7~71SLL ^~~ +. <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM " ' "' ' ' TO ' r <br />(2011/ R2-231 71425/ R&2)1 (2829) (30J1) <br />Form Approved. <br />Ne ,,, ., OMB NO. 2040-0004 <br />Approval expires OS-31-98 <br />reft^v v ~I <br />C - nr D1'IT. <br />.•T•i .. Trr•v •. •r^c Tn rnTn •r <br />"NOTE: Read Instructions betg~eting this form. <br /> (3 Cud OnyJ QUANTITY OR LOADING (4 Card Ony) GUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 46-53) (54-81) (38-45) 46-53) 54-81J EX OF TYPE <br />(32~~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> ([<rt®) 546H) 6370 <br />r SAMPLE ..:- ~ ... `~:: :~ -rtr.-:.-~ T ') <br /> MEASUREMENT <br /> PERMIT <br />~ <br />_ r'i li ~: 1'+T -:KITS VALII} REO <br />UIjiEME(JT ~: - <br />-:. C!-3F ;~~`~ <br />~ - - <br />y • =~(RT~~(~~- rn :. L <br /> _ <br /> <br />.. _ , <br />; <br />. <br />- ~ - <br />.~ ,, I J SAMPLE rr,:: :ZG3X~'- 41`a"+t7r ( 1 9) <br />''J.Pr'iDFC MEASUREMENT <br />' <br />~'~3G 1 ~ 1 :~ PERMITT ':-x # ~ ~r.~- irtf~ ,dEx -; - <br />• <br />.~r'..I.it?AIT' :;?'1ti5 YAT 'T REQUIREMENT ~ ~ a" x,yCr df~~g~ >E ~G~ f}1)~~'"~' ~z,< rr,/I. {~' <br />' ~I~1 <br />..~ SAMPLE ... cif r's. r. ~. ( T g) <br />:`G i4L @ECOYvN~I?L-' <br />' MEASUREMENT <br />UT.^n <br />) 1 0 ~ <br />PERMIT - '-": v~ s t.0 :. 1+~PttR t".": MRP$JC, r~~+ '.=.a <br />.?: F!.9 f:NT G@7S5 e51. 111 REQUIREMENT -%r,.: .,..~,; <br />•,~ 30DA; i1 T"„ flAT'Lr dM1C '^-/T, !17p7M _.,~: <br />. ". ~Y.n, y- KAI I'_ SAMPLE -• •;~tC:: 'S'kRO'-'• / ^•}I <br />I'i:~`_r'')LY>'~ MEASUREMENT <br /> <br /> <br />~o~', rt :.;uT ;,R~-~ ver Ir AE~O AE EN7 '!~+' T <br />__-rcn, 't .. SAMPLE xax^C ~~'~^~ ! 17) <br />'J 1 S.; _.' L Y g C MEASUREMENT <br /> <br />1SCFi 1 C J PERMIT g '~.~~ + ~~_ ~..~ ~+~ ~ -: <br />: If~~'I'~. $R EFL f' .RJL E)' <br />';rF;,U°,T ": P"1 ii 74LR` REQUIREMENT ": +'t~R _ <br />`++ <br /> <br />.+1 v - _ . -.." ',~ SAMPLE x''` •- r g;. yt rr^. ,..y~~r. ~ TOT <br /> MEASUREMENT <br />' <br />t 0 <br />D 3 S •1 ? t <br />PERMIT' -- r--„^ fs -0ttr- ~~O'+#4d ~ . ' -, <br />t <br />~- <br />'R1 <br />-'PFLU"'T :: r+~SC YAf.^~ REQUI,REMENT ~. ." ;Yr-r ~ - <br />. ,,, <br />liS. lSllx . <br />r/~. GEA/T ' <br />.+` <br />t n' „ r. :, :., I'. .. SAMPLE ..-... ~. _?s;;a t .... .nr.: / 1 71 <br />." ° C 7' 9 4? L ~ MEASUREMENT <br /> <br />.i 2' ] C ~! PERMIT ''`'`~ RSP4JPT RR "t)PT RR$fil :P~~;:- <br />- :' :. 7 ° q °, G r) rf : ~ V r L" ' REQUIREMENT <br />" - ~ .'i':' <br />30nA1 ~eT, <br />DAILY PE <br />vr~l, <br />t10R*i+ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR Wm1 THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY TELEPHUNE DATE <br /> <br /> <br />Richard Mills <br />INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BELIEV ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE <br />BM <br />TT , <br />' <br /> , I <br />ED INFORMATION IS TRUE, <br />SU n <br /> <br />c.TViranmental f~anarler ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTING IPM AWARE THAT THERE ARE SIGNIFICANT <br />FALSE INFORMATION <br />INCLUDING THE <br />97~-87~-17)2 ~ ~( ,{ <br />_ <br /> <br />POSSIBILITY OF FINE AND IMPRI , <br />SONMENT <br />SEE <br />ND ~ / f <br /> . <br />1a U.S.C. 41001 A <br />33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE / <br />TYPED OR PRINTED <br />p <br />muimumllm~rnmenl o16eMee n 6mon0~enltl5~ 5ne,9 up ~ :10,000 erM a <br />y,,,s.) <br />OFFICER OR AUTHORIZED AGEN7 <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> D <br />COMMtN 1 S AND F>CPLANATIUN UH ANY VIULAI IONS (HB1BrenCe ell eReCD/IIBntS RBIeJ <br />,,. ~ .:g4A~r' - :I' crl -;^.1 '.T. .'/, °. ~. y:ry^ qcT C^rt.~l, ..7"' .. _ ..r ;.~.. ,, ,+~,. f. T_/. r mrr r '.. .. ''T, . <br />^i "4 A T' rc~, <br />_r <br />,LS - FC7T y~r•^ '/. T'i jV t'C'I°TV; - .i°E ~T'1°cTIT TY - ..+.-I'I ~~ 7° CemT'IKAf r. 3. <br />EPA Form 3320-7 (08-95) Previous editions mey not be used. (REPLACES EPA FORM 7-40 WHICH MAY NOT BE USED.) ,I ,t T r T / ^ ~ r 1 : °~ r,~ (~ PAGE r OF <br />