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PERMITTEE NAMEIADDRESS!!m'lude <br />farilirY Name/LOrariondd//ertnr/ ' <br />NAME .:il~ !nil i-ilA ell';}>Ah <br />ADDRESS (:(1 •;jw Yl~"ll K~:-----_-__-- <br />---~FS.~:~--------S.I~ t~,t tl)---- <br />FACILITY ~ _ _ _ _ _ __ <br />LOCATION- -_-_-_ --_ _-- --__---_ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (/YPUCJ/ ~ ~••~~ • •rr•-•--~ <br />DISCHARGE MONITORING REPORT (DMRI ~ OMB ND. 20403004 <br />11-161 /17-19/ r' - r ! ~: A L Approval eiplrag 83¢81 <br />C(n;ci ill;l i 7 Ii0 3 ~ [, :]r. 1. _' cult IrI L!': Tu w I L:.Jrr ~. :: I. F.1 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD - ~ <br />YEAR MO DAY YEAR MO DAY <br />FROM ~,- ~, TO ~~- ) ~ i.ia:~]i2 (~itJN NN~ y1>YA'r , <br />/1a111 !11.131 III-111 /16-171 /78-191 (Jail/ NOTE: Read Inetructlone before completing thle IorT. <br /> (3 Card Only/ QUANTITY OR LOADING /I Card Onlv1 pUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br />PARAMETER (4613/ /J4-611 (38~J) 14613/ (J4-6!/ EX OF TYPE <br />(31-37/ AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(61-6) ANALYSIS <br />(61-681 <br />/69-70/ <br />I .. .: .a 1. .: 1:1•;ASt• <br />SAMPLE .. .. ;: , .:-c::::: . . .. . .. . . . <br />_ <br />t , II H 1 MEASUREMENT ~ ~ , <br />,•; ., I, L O O PERMIT (tti/,il}fA'w- I' O ~ Y L.~~sl -r:{ti:J{Il:fj z:aGa~r::r ot,#G~A•'.+ ,:4 :, EEKLY I$UAL <br />1. •)r:!r ~i' (:ROSS VALUE REQUIREMENT ~- •. ~' I}1Si nx~ '. i7=11 - ~ :u: l~ - s. I <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT I <br />' . • 07 <br />~ <br />- - - s <br />~ ` <br /> REQUIREMENT : ~ ? ,. I <br />~ ~ ' I <br /> - s <br /> SAMPLE <br />MEASUREMENT ~ / ~ <br />i <br />~ i ~ ~ L <br />t <br />YJ• / f , / ~ , <br /> f~ / ~ ~ <br />' - <br /> PERMIL <br />~ .~ <br />" ~ . <br />C1 L <br />- 1 : ; <br />v i <br /> REQUIREMENT ~ <br />+ ,- ,- un <br /> SAMPLE ~ .. ' <br /> MEASUREMENT ~ ~- <br /> <br />' PERMIT <br />~ <br />~ - <br />L <br />- REQUIREMENT - <br />~ ~' ,. _ ` ~ ' <br /> SAMPLE <br /> MEASUREMENT '• ~ <br /> <br />PERMIT' <br />~ <br />I <br />.' <br />_ A ~ 1 <br /> <br />REQUIREMENT <br />•. <br />~ <br />"' I <br />- <br />ci ~ 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ - - .r } j <br /> REQUIREMENT ~ - - ~ I <br /> a. <br /> SAMPLE ,, <br /> MEASUREMENT <br /> PERMIT - - ~ ~ ~ <br /> <br />REQUIREMENT ,' <br />- <br />' .I <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE P ERSONALLY E%AMINED TELEPHONE DATE <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTE D HEREIN; AND BASED i <br /> I <br />I <br />I <br />M <br />DI P <br />r.. V. NTnIh:)OCJ BELIEVE <br />RE NFORMATION. <br />I <br />THE <br />SUB <br />OBTAINING T MIT RED <br />INFORMATION <br />~ <br /> <br />r IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG ~ <br />~. ~, 3U3 014-44SI Oi I4 .Z <br />Vl' LiaNL/]sIJV1NiiNi lt;[JTAL AFFAIIt NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING l <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT. BEE 18 U.S.C. 6 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 33 U B C. 1 1310. lPma/ria under rhar smrvra maY inAudr Ina uP ro JI0, 0017 <br />aneor masrmum rmpruonmrnrq/brrwrrn6monrhr and lYean.1 <br />OFFICER OR AUTHORIZED AGENT <br />D <br />E <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> O <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (R~/errnre a!I arlachmentT heel <br />. .1. JIh i. S.h F:AS=--Sk F, ~r'~1l'I tlr/1'r. h'/ iq !ri}: i'c:(~9(i. :i d1'r L[.A61. 1; ~1)1.L!)S Tt5'r 11i;~Ulti r;il Oh LY IY' <= 1O-Y ne 2U-hr.' <br />r,.L:~k' i:'l4N'r CLAT"I:II. Ir CLAD, ,. :, ,, :'GJ:.I, r,Y :I'!t:u, '!'S:; t it•~./ i LI IC'1'S IiLL tifi'r ,t k. ;,r ~:'LIEb rJ n~k'O~Y'rEU <br />EPA Fb m 33 v.a88) Prev/ou9 /t/ohs me D91/994: ~ ~ ~ ' ~ (REPUCES PA' FOR 7 'NIGH MAY NOT BE USED.) OF , <br />