|
PERMITTEE NAME/ADDRESS pnclude Facility Name/Locadon ijDiffecent)
<br />NAME
<br />ADDRESSit'S-."6 v.) ''i::.
<br />FACILITY ~ ~ Y' ~ L Y _ i ~ ~+'
<br />LOCATION
<br />,; J~'F'
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ Farm Approved.
<br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004
<br />°i,, j,,
<br />PERMIT NUMBER DISCHARGE NUMBEfl _ :. - ~ p L
<br />MONITORING PERIOD '• 5 - 1 ., .. .: I ~' T. ,' ~.; >, -; is . F `':~
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~~; ;1 TO J1 J sl -- '~ ~ "~~'-•~f :~:.. yy ' '"~~'°
<br />' A NOTE: Read Instructions befo~e"~rripleting this form.
<br />t. i.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br /> EX OF TYPE
<br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNa.vsls
<br />~. ''_ildS SAMPLE ~-.. ..- .. ;..fir: ;:-- ( i„)
<br />(t„ _. ,, :_'! MEASUREMENT
<br />., T i ? 1 l: PERMIT #'x 6'¢~# ii#iRVA61 4¢#4tRR () ~ S !:1 NC$,J 13 a'$'" "
<br />- ~ L - V AL J r' REQUIREMENT ~ ~ 3 D Yv 7 V °"~ "'<~' ! ..~,~~
<br /> SAMPLE .: rt .`-:: ;: r: ;= ;:{:=.,:': ~; ( ~-)
<br /> MEASUREMENT
<br />• t t P~EIMIT .':r#YFakgrAt9t' ,.
<br />,- tK0 f:•- ~5
<br />,
<br />- - ~ .:.' '~ f, ,~~ -. 4 ~ ~~~+LY 66 ~U
<br />= L. J i ., J :., v S L U c. REQUIREMENT - . -
<br />~ ~
<br />(
<br />P4 1.1 ~ (S .8 ~.'.r --
<br />- ~:,L:-'i.~ -..4L SAMPLE ~ ~ ~ ~ ( 1?)
<br />. ,,. I, MEASUREMENT
<br />~ : ~> ; ~ 1 L, PERMIT hag#ii# p#rzAt#p .. #~###di 5 Q
<br />-,
<br />•.-. - ~~ Rd6i
<br />- ~ ( ~ ; ., j ~ ~ y _~ i, ~ ,-; REQUIREMENT Cf r ,
<br />r
<br />n - ~ ~ r
<br />, L ~ SAMPLE = x -.. ,. .... .. .- .... ( ~ r, )
<br /> MEASUREMENT
<br />.,. :, :i •, 1 U PERMIT "+S6CtJ3# '-0iC#R## 5~ '::. :i r)t tE$#$` Ya#',i #'4;Y ~ -4' ~
<br />~~~ 6A8".
<br />.: , J 3': l' d I. L ~". REQUIREMENT N . a. ,
<br />` ,. r '..
<br />l .~y~ !~j;'.,i SAMPLE . ... .. .. _. 4##4:p:~. ( j r)
<br />( ,~ ~ ;) MEASUREMENT
<br />~ 1 ~ 1 U ,f ,. .PERMIT - P#es s7txQ #At=~~A $ ,. n'~dl~l#ta 3.5 .t•". •O ~ j
<br />y 6/1.8
<br />, L ~' :" T I x.11, u c REQUIREMENT _.rr -,' j
<br />l: n I ti ::', _"i.' f -~.l SAMPLE ( ~~j) .. .. ;=6a':O'`
<br />...
<br />.##r:
<br />••, ~~ _, ., •, A..• MEASUREMENT
<br />
<br />
<br />.~ L !
<br />
<br />°PERMIT
<br />
<br />Rr:POdP
<br />
<br />d~Eff '"~` . ,
<br />. -
<br />'-fr~tl)flgf## ~'
<br />
<br />..-. ...
<br />
<br />''~'a
<br />
<br />~~1F'V
<br />
<br />[IS?~",
<br />:. ,i ~- ;~.:. 7lL,i_ REQUIREMENT 3fJUA i1 M'~ ".+J :]G ,
<br />',L' '_. ;e _ ~1. SAMPLE ~ :p:f -"k' .r, :. ..-~~- ( 1")
<br />„ 1"t. MEASUREMENT
<br />•. -, 1, PERMIT N~eS#~R "Cr4#40Ct # `:. G#####~ #i#4';-a ..t- •S "=
<br />`
<br />
<br />_.. ~
<br />
<br />..
<br />
<br />.$~,
<br />I REQUIREMENT _...
<br />~ x
<br />,
<br />NAME?ITLE PRINCIPAL E%ECUTIVE OFFICER I Ceniry antler penalty of law thel this document and all attachments were TELEPHONE DATE
<br />{ F -i-
<br />:~ r: 5 ! CII t
<br />T
<br />(
<br />- prepared antler my tlirecuon or supervision in acrordance with a sysem tlesignetl
<br />to assure shat qualified personnel properly gather antl evaluate the mbrmation
<br />.
<br />li.
<br />~
<br />J/~ _~
<br />/
<br /> submined. eazetl on my Inquiry of Ne person w persons who manage the system,
<br /> the inbrmation
<br />or NOSe persons tlireNyresponsible br gathering the lnlormation
<br />
<br />L
<br />r~+
<br />~ ,
<br />h
<br />rate
<br />ntl
<br />lete
<br />th
<br />f
<br />k
<br />l
<br />tl b
<br />li
<br />f
<br />tl i
<br />b
<br />tl ~>
<br />'
<br />' _
<br />'
<br />'~
<br />2
<br />l
<br />, I ~
<br />~ , a
<br />.
<br />e
<br />my
<br />now
<br />ge an
<br />e
<br />e
<br />,
<br />ue, accu
<br />comp
<br />submine
<br />s , to
<br />ast o
<br />e SIGNATURE OF PRINCIPAL E%ECUTIVE L
<br />/ ~ .
<br />S
<br />}. •i
<br />'
<br />TYPED OR PRINTED I am aware Ihat there are s,gnifram penalties for submining false Inbrmation,
<br />includin the ossibill offine antl im risanment for krgwi violations. OFFICER OR AUTHORIZED AGENT AR NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />r
<br />EPA Form 3320-1 (REV 3/99) Previous editions may be used.
<br />~. .-, ~e !
<br />THIS IS A 4-PART FORM PAGE OF
<br />
|