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PERMITTEE NAME/ADDRESS (include Facilin'NamelLacarion ifDi/ferenr)
<br />NAME _ ,',: ~. ;.S ~,r~t:. ~Et ;v r'!'-.
<br />•e
<br />ADDRESS b_ _i is ,; t 6 J ' i N f~
<br />FACILITY
<br />LOCATION
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
<br />- ~ .,, r ., I i .
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '! I °~ ~ ~' ~ TO ~' 1 't i .f 1
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />,.,- 1 x..0'1 S'C'T., 4.~ T.l . [, . A.r^
<br />.NOTE: Read Instructions before coCmpleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMET EX OP TYPE
<br />ER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
<br />' SAMPLE ... .. '.: r:i:::;:~ ( 17)
<br /> MEASUREMENT
<br />. ' i ! i PERMIT 45r.C+Yrttdl 91##4#4 ~ ~ 6. 5' Ors#### 9.0 - ~£' 8$ df5tf+
<br />r `~" ~7 .: -~1.:~ YALI: REQUIREMENT - 4(' MI11QA ~ yAXIMtl14 5 ~. -? r+,;' -
<br />,tL(:~,;, Iv: ,L SAMPLE r. ~yla:~r: :; ( I~)
<br />~ , _ ., . ,.. MEASUREMENT
<br />l: , ~ S) i U PERMIT d#39r3=i -li411s#0#
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<br />`: I_I, .-'.I `:;5 6?. L';_ REQUIREMENT '~~: .'~.~ 300A AYu D ILY 8X NG/L ','L'Py'N $
<br />-::'--., ~. ..'I'*L:";'L.. SAMPLE "~.;:r x': .,-: •. ~:
<br /> MEASUREMENT
<br />'i : : ! ^. J. J '.J PERMIT _ 3iFa S.CA RiI Le##Q - ,. #At##CtA! ~ @$$Q){'(' '" RE~C+#3R! :~ ,$!(~
<br />t.r ~ i.~•'•f ., rT~~ yhLU. REQUIREMENT ~ 30DA AYG DA °~ !;
<br />, , : r: .: i ~ ' SAMPLE -:.. .....:. :.. _.....:. - ,
<br /> MEASUREMENT
<br />•: ~ ~ ~' I T " PERMIT Cats MRk ilt4icdr+%?` `0p#O4# ;%p##t3 Rs IO - ~~ H*XI
<br />t,.~ ~ P '.:~tJ35 'r;L'J:. REQUIREMENT - ~' MS ~ - .
<br />I. I°, :1i1'AL SAMPLE -... .-. ..: _:r ;. .. ..: "~)
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<br />(n y~') MEASUREMENT
<br />,J.: i . 1 It PERMIT a$¢~frs ar4tersR ~ . Jt!k644 3.J F.D ~~ R68
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<br />. REQUIREMENT zr r,'. ~ ~ 300 AY^ L
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<br />F: .,, .n , SAMPLE ( 03) .'. .'r :~. .. «~.. ;r.
<br />. ~ n - .. _ , !~ „ ~.. N q MEASUREMENT
<br />~~l:.l J 1 J ~~ PEAMI~: ~ - REpiYa~. ,~~Q~~ "- `P4Ct#TT3 4'!~>l~lOe r.
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<br />.. ,•: ,r« ',`~'" ~ B~$Kbt ;t~32A
<br />c. .'' ! ~>. P ]d., Y'. i. ;S .` REQUIREMENT 3DDA AKA DAI LT !1Z ."";~; ~ u{'rf -:
<br />~"!!. i.`;, ft:';L SAMPLE ~ .::{: -: ~: ( 1r/)
<br />~;i_ ~ .~~,, MEASUREMENT
<br />/ i-~~' i .• '! PERMIT. ~ R##:A, ~ 4#it##¢ .. #4!4a$FiT -- APO@T .. )YTS Q1fAL- :.` 'X$L-Y H~
<br />h. '-'' T Gt.S: V.11, .i: REQUIREMENT ~ ~ 'RT AYu R k '~~;/ .
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I Ced,ly under penelry of law met this document and all enacnments were
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<br />to assure that qualifietl personnel properly gaNer and evaluate the Inlonnalion
<br />~ 1' submitled. Based on my inquiry of Na person or persons who manage Ne system, - i'
<br /> or those pesons direclly responsible for gaNering the information
<br />the inormaion
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<br />submided Is , to the best of my knovAetlge end belief, true, accurate, entl complete.
<br />SIGNATURE OF PRINCIPAL E%ECUTIVE ~,
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<br />TYPED OR PRINTED I am aware that there are signdicant penal6as for submining false informabon,
<br />indutlm the sbili o/fine antl .m nsonmem for knowin violations. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
<br />i .i- .: t'A i. lN'. .. ..['., -.. ~ wa'i '. , .. '.rL'~~ .. ~.,~ ~.,['.L ~~ r 1 ~~ .,~ \=i'/Y :, )(~::1 ~i~ °,V -
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<br />EPA Form 9320.1 (RE 3/99 ~ revibus editions~may be used. 0 ~ _, 9 G / U C ,~ ~ iTHISiS19 4-PART FORM PAGE t OF
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