REP20185 - Laserfiche WebLink

Home Browse Search

PDGQI'fEE NAME/ADORESS (lnrlvOe Feel/hy Nime/L ,tt1Jon IJ di?ercnl) NAME_Oft N~p.l 1, 1 'i: ~(1 :!i• _-c------ ADDREw2j9~f_, .:.)iii: i t 'i74L 7? ----- - JAY, ;:i'F.!; F~-/-~-~-p~-~/--J :i i1~ 7__ - - - FACILITY -_~k _.l~y~Qe~_L 3L OF1./-`------ LOCA7IDN _-J~1EX-sGO`~LIA1~------- A?r17; I)AVli1 .nN'IIIIG NATIONAL POLLUTANT DISCHARGE ELIMINATION IYeTEM (NPDES) DISCHARGE MONITORING REPORT (DMR) (?-I6) (17-19) rnUO±:,15:1 r„) 1 PERMIT NUMBER Rnc.Awoc Nwecw MONITORING PERIOD YE. R MO DAY YEAR MO DAY FROM „ ,•y TO _ (1(411) f11-171 /N-75I Rb-177 I?d~19) /)0.]11 i ••,, (:; IJ !I k ': '• ~ Porm Approved. ^ ;' - c i •,~ L L OMB No. 2040.0004 T iC!I S ~•'_ [ ~~(Ipprpval. p~plreF]D131!@4 NOTE: Read instructions beto completing this Corm. (J Grd Only) QUANTITY OR LOADING (4 Cent Only) QUALITY OR CONCENTRATION PARAMETER (46-5J) (54-b1) (38-45) (46-y3) (J4~1) ~' FREOA+CY DF S7ry PEE (31-3)) ANALYSni AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS l61d3) (616d) !b¢IO) ' , ':: is ^J•' :~(: `.: !: ( L~~ SAMPLE MEASUREMENT OG3C0 1 G ~ E "'! O c t: t;. do IG 4.0 6FKLY Ak8 FFLUENZ :.iiJSt, VhLU? RMIT P REQUREMENT a.b:: ~IGIRU!1 :'1kX_TMUIM ~. :^'''~:: DS, .i F:Z'LE': Lr: r .,. !: r,: ~: :2~..;:-': ;t ,: :;, t:.•.: ;•^ ( ,-.~ SAMPLE MEASUREMENT JGi45 1 0 G r• 1 a r-oa ~ PPtIDNk~ NCC/ Aq P~~T ; EF'FLU`:N` uRJSS VdL'J REOUwEMENr :ti:xc:~ 3UD.A AVG DAILr hX .!!,/:. fSON2H ~•y ' SAMPLE {.SU ~~ L X [ H ~ la (? A I( !', =;? H MEASUREMENT DGS50 ], D V >J'.I , : i. r . . ~ O.r 0 T aN;'iMi itkH cFFLUE;II .."rkJ55 7ALD'' PERMIT REQUIREMENT 4:Y/i^• IN$^ MAX '.:/`. G$Y'~ ' U L' r '~~f - SAMPLE T •! { IJ T 9 ~ h Z Y.°•!7I " L A ;i T MEASUREMENT °rJOSO > ;, c - !• ~v .• ~~"~ •:` : srt=tr ,~sxall °FF LU'r.97 r:ItJSS VAL!t : PERMIT ReQUwEMENr 30 DA AVr DkII-Y !fY ".:D ' SAMPLE D l S 5 01, ~- ,1 MEASUREMENT 7~J2 )5 _ i ... nr:;: ., r• c - G. A 1 :• T R N PERMrt . e~FLaF:r+I :a:;ss YAI,~!, REQUIREMENT ~'7:% UBTF: TfvlJ RRrN !'.1X ~;/:. SAMPLE y i j ~ _~ L MEASVREMENT ~~665 1 C 6 :n b, ~;,=1 , . ,l,:r .I,.e,=b.::F BEP Y at1AL PERMIT . ~ EFi'L'Jc:R;' :: !;l1jS i'?, LG. REQUIREMENT IliS".' ftAX :i,l=i; ... ' SAMPLE „ MEASUREMENT PEAMR ~ REQUIREMENT ~ ~ . NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnFV uNOER PENALTY OF LAw THAT I HAVE PERSONALLY E.CAMINED A!A AM FAMILIAR WITH THE INFORMATKNa SlIBM1TTED HEREIN AHD BASED TELEPHONE D A T E ~~~~yy//((~~ ~ ~~~/ mING E I~ ~~M Tp ~ EIY ~+ ,a.i.` OMPLE E AM AWARE TIM THERE iLRE TRUE CIIRATE T F GNT TIES F BMIT? NG FA E INFCWI TCN INC GYNG S L R S s^ Tr RE '// I O . M I PENAL U I LS AA LU THE POSSIBLrtr OF FINE AND MPRISONMENT SEE IB USG f 1001 AND 33 USC f 1319 lFkvnin unCer rMSe urturcs may 'nduEe fma up m SIGNATUR OF PRINCIPAL E%ECUTIVE n ( W ~ V, 1 /•jzf I - rb ra f10000 d i ! b ' b M J OFFICER OR AUTHORIZED AGENT P'REA TYPED OR PRINTED mon ~ an yr maxrmvm mORSUnmens o erv een s a ra/ NUMBER YEAR MO DAY COMMENT AND EXPLANAnOrv off ArvT v1oLAl Iona (wemrtntt an auacnmrms nert/ ~, .. ~. -{ .: ~-.-- %~ ...:!?'. .. '/. T. ~O"" -, IL. ., ..:. .. i - •, ~.. .L. .. ,.:~,'~ [I ,- ~ -. .'. -`~~ t".~CIP a EPA Form 3920.1 (Rev. 9-88) F4evious edilion5 /nay bC (6E(1. (REPLACES EPA FORM T-AO WHICH MAY NOT BE USED.1 ~ ~ -. ~ / I (j ` i PAGE OF l - 1 . ]