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PERtaRI'EE NAME/ADDRESS ((nclude F'aciGry Nmne~Locmion iJD(f(erenq <br />NAME ,. r r, .I . r - ., _ ' ... _. ' :1 ' . . <br />ADDRESS~IY45 Le'`;'* ?nr ..'r''a` ^+ <br />~~4.-U; 1~_.. <br />FACILITY - .~ 7 ' ~ I ~ ~ ~' <br />LOCATION <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) FOfm AppfOVed. <br />DISCHARGE MONITORING REPORT (DMR; <br />P <br />+ OMB No. 2040.0004 <br /> s( <br />rz- I <br />m- ~ : <br />i - ~ ires 0531-98 <br />A <br />l ex <br /> . p <br />pprova <br /> <br /> PERMIT NUMBER DISCHARGE NUMBER ., <br />_ <br />.~Q'I <br />~1'i'- <br /> <br /> MONITORING PERIOD "' v " ° `' ' ^ `~ ^ L '~'~ ' ll7' '. r. <br /> YEAR MO DAY YEAR MO DAY <br /> <br />FROM <br />TT <br />~' <br />ll <br />TO <br />7~ <br />n~ <br />t. <br />\.~ <br />A .~ <br />n. r~• __ <br />~\:: 1 I <br />(zaz+) (zzs3) (1d~Q5) rzs-v) (1B-P9J Boat) NOTE: Read Instructions beforezorripleting this form. <br /> (3 Cud Ony) QUANTITY OR LOADING (4 Cud Ony) OUANTITV OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) 54-B7) 38<5) (<653) (54-B7 P~( OF TYPE <br />(3237) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~~) (~-bgl3 6370 <br />Z'J! <br />' <br />- <br />' <br />' <br />• SAMPLE ~ .. :xic ytx}-.. r..; ....,~.~ <br />O <br />lO 1 <br />13 <br />D <br />( T'1) <br />O <br />3~ <br />I n <br />G~ <br />:1: <br />4L "_ <br />] <br />:7V <br />.;>,. L` MEASUREMENT t ' ~ <br />;,09:7 ? .. PERMIT ,RtaIR4#M •#0.##pR fi#kilrtOOT I.Q ~ <br />~ RKFCIRI'' NR~1'.) '` ~~~ <br />':Fi'L[t;..," .."';' V4{."= REQUIREMENT ~' ';~~ rc[`-C. <br />~ ?3QD "': 1<' v^/§ ~A ~7T ,`r~~'i~A` <br />iILY;~.'~ rt ^.,.i^1-ALLY SAMPLE .-7.'k."R .:xGSt ~l:!3v <br />¢rk ( T•)~ ~ <br />~ ~~TT(~~ng~QQ <br />CT>;Oi-'! ~~: MEASUREMENT , o O1 D ' `'7KJIr <br />D1ih0 ~ f+ D t+';°,~P~RMIT~ ~'~.".SD# #O~CI s' ##~ '~ ~, <br />~) )„ Rb <br />L :` _ .,v: <br />v•-I. U"v ~ ,~R7;~ V6LDe FiEOUIREMENT ~ ••f: ••e - ='~7#b• "" T§ 'f'.:`-i e•-7r ". f.. <br />~C°"'~4~ p^TF'.'lTL~LLY SAMPLE ,. .. .. .. ,.. r....h~..., ! 1 ~' ~/ <br /> <br />_ i _ J L V °_ D <br />MEASUREMENT <br />O <br />Q . pO ~ <br />O zz <br />J 1 ~n <br />hC.A ~; <br />..iillu L D ') PERMIT `; a>k 7r$3x0#" t^R $cL$gtpra' I}aQ7~ <br />~ nJ! " tY;. <br />}' (. it ~ R T S R 7 S 5 V 9 t, ~: ~ REQUIREMENT; z gOa3 ~ »r / r ry p. <br />_, <br />.,,~~`iFSLr T7TAL SAMPLE t>r rr "•.~ ..x..".. ,... $... ( 17' / <br />!' ". C'J v `, R P H L P. MEASUREMENT O ~ O 3S D ~7K ("U. <br />i11!3 l 0 9 PEaM *zaaaafeL +'-7 as:a :~r-r o#I>!r R°fz()R? l~R,PC11?t 4 EP.KT.[1 ~9t~N' <br /> <br />r'Lll:;ni ~R7S° r' ic REOUI 1= NT <br />i <br />~ - r <br />`~tz~ _ <br />4iTfl <br />T.Y ?l <br />"7T - - <br />:LJ+e IV C7NI'7L' 77 SAMPLE p^ ( ~)) ~~sx•cr: .. .._.. r:x^,^,•,. (. <br />I 1~Yp <br />II"0 TRE4Tr~ •'^ .~LAc~ MEASUREMENT O O I n\~a. 1 ~~ ~ ll~rJll7} <br />5!l')7D 1 7 '! PERMIT RB1,-QR'P RCP~Hl:: 4##RQtgl ;-##?T9n2 Er 4kr~r#+6 y1 vP <br />RLY <br />'R5T,1LB <br />^PLDF.'rT .:f:7~`; Y:t,+I ., REQUIREMENT -.~ .- A ~: ,h,.7 ", <br />:JTL A.ND ~'(c4iF: SAMPLE .#3~:`~•'c <br />O ( 7R) .;`t.,Y .': .r~.~......; ti*."yt '1 <br />-7~ <br />' I _; IJ P L MEASUREMENT O I Kuril <br />34Di,6 1 !1 D PE[iMIT; #i0.###0§ Q Pi=1 ~-4##ifjE~tte +a4+0e#$TM ##~'A~1~~~ #:':^ A'k!T'{,T iTS~L <br />r Pi~Lt1 E:"iT :,R~ :: r+t ~. REQUIREMENT [JIST "(y=~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME(TITLE PRINCIPAL EXECUTVE OFFICER I CEFmFY UNDER PENALTY OF <br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN; AND BASED ON MY ,~ <br />ce TELEPHONE DATE <br /> <br />INOUIRf OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING /i <br />r ~ <br />may, / <br />iiicf:BlCi ti~iIIS <br /> <br />' <br />' THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION la TRUE, <br />ACCURATE AND COMPLETE. 1 AM AWARE THAI THERE ARE SIGN7FICAM <br />P T/ /,~~~A .> <br />J ( ~ <br />~ <br /> <br />97 <br />; <br />7 <br />717 <br />' <br />( <br />J _^ <br />y' <br />] <br />/ <br />1CI <br />!iV)rOrl f°E'1t,( r~,.^.li ~> <br />- ENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />F FINE AND IMPRISON <br />P <br />B <br />LITY <br />Hf <br />EE <br />B <br />S <br />C <br />100 <br />AND 1 <br />U- <br />D-. <br />. D ~~ MI <br />I <br /> OSSI <br />I <br />ME <br />. S <br />1 <br />. <br />. § <br />1 <br />O <br />U. <br />33 U.S.C. <br />5 1319 <br />P <br />/4' <br />d <br />m <br />r <br />n <br />i <br />l <br />d <br />ll <br />ro 510 <br />000 <br />d SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED es un <br />er <br />ere s <br />e <br />nes mey <br />nc <br />u <br />e <br />rtaz up <br />, <br />. ( <br />etu <br />en <br />w <br />maximum lmglsonmenr of belweenBmwrths arM5yBSrs.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIULAI IUNJ (Hererence 811 enacnments nere) <br />L'°"~°;IP"': r .r ^ ,. ,.' .. - ...r f.. ~ ~r -~~ TES (( )(' r-N) a Orr v -, .,r a rr ~_ r~_r~r .rr_. '." rT., <br />•r• <br />°?.4I'i40• .~r ~~e~7r r~. 1'i, "7R ?. ri^7?;. 7_°. P477P al,~a:Tnyy..r r•~-~ ,irr .. q..5 ~e__'rr rl...~... v'r. rP ~._ .rr <br />EPA Form 3320.7 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WNICH MAY NO7 BE USED.) D,i ~ o ~ 7 ~ T I• ry " "- L s ~ D PAGE OF <br />