F'ERMITTEE NAMk. ~SS•p,.i,4 isWryNrrlxu,w l/OJO.rwU
<br />NAME '
<br />i;ULU '~4t. C!•IN:I'iiJY L.Pr
<br />ADDRESS C, L11.:) r: Y r1 '•1 T ': f'
<br />`,731 ';':'6'4!. !?T:;tI;:6Y l3
<br />FACILITY
<br />l
<br />NATIONAL POLLUTM. MOE ELMINATOM SYSTEM (NPDESI
<br />DISCHARG ITORING REPORT IDMR/
<br />x;
<br />! PERMR NUMBER D14CHMOE NUMBEfl ( U tl ~~ ~' ~' 1
<br />~ - F' ? h r. 1.
<br />d 16.E 1 MONITORING PERIOD ~ r N C! s. I
<br />Form At. d.
<br />.,. .,OMB;N 4004._.,
<br />Approve ree`OS-31-98
<br />YEAR MO DAY YEAR MO DAY
<br />_,
<br />OCATION
<br />TO q4 17 ~) ...;; .in ••, ..;•... e• c ~ I ~ ;:{ r:
<br />rl 1\
<br />P~ N~n. ~,(~! t ~ FROM qt3 L!) P1.
<br />.1'n
<br />ifl C
<br />,(
<br />:
<br />-`
<br />_
<br />,
<br />,
<br />,
<br />. P.
<br />,
<br />NOTE: Reed InetnrAlqu beiwe 2eTPltlinp thb tofm.
<br />-rr^Fe=+-}y?-«I~ r-f--r'-F-;~- 1 !16311 /71-731 !7476/ 176771 I7B-791 1.~3I1
<br />PARAMETER 13 Grd Only) QUANTITY OR LOADING !4 Grd Onryl QUANTITY OR CONCENTRATION NO• FREOUENC'Y SAMPLE
<br /> (46531 l5b51) /38-151 4653 151-61/ Of
<br />l31-371 EX MALYSS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (u-e]I 360-5B) 159-70/
<br />• SAMPLE _ Roc :r.} ~t::: ~.:'t :.`-:S :: :5,}rt : ,;:
<br />~
<br />~' f t ~) _ I`J/. i
<br /> MEASUREMENT ~,H G
<br />, i ~ /: , I ;
<br />J:),i ll (1 ~i U it '~.'~'PE.RMIT:~ ~r. ~t'r t,:~r,: it z: C'-.~~~
<br />~
<br />~ ~ ': 4:fri;:-s p; I::;r
<br />~
<br />~ ~:~ri6;1 r<~i5r;: .',ly !{..'-..~:.~'~
<br />~
<br />~ ..
<br />
<br />.Y
<br />.Fr'i.U c:r.., i;F~~S'.'; l'.A I. IJ! REQUIREMENT .. ~:~:: ~~~~.. ~. ~
<br />:~
<br />' ~ ~ ~. L:::r: r,: : ~;:
<br />*'T. :: Tw~O ta
<br />~ .. ..: (: ~.'.T ~u.,~,.
<br />- '
<br />. ..
<br />.
<br />;UI,: ll`ir Ci7 ~P F, 1- SAMPLE .:, rt;g¢q .':+'; SI .1,t -t .,,rn~tr (
<br />, .)
<br />~' I
<br />,
<br />il;; t' r ~ it . L` MEASUREMENT L~ "~ L/ ;
<br />. ~
<br />1
<br />,J`,3U L U ; PERMIT'., rr,:.^,161p rt.. :::: :::....:: ...
<br />. Y,.., •7O-:`.'Y
<br />:
<br />r,: KI:< rc,. r
<br />~G'. re •5~1k .: .
<br />'j5 :' ~'
<br />
<br />~ r..:::... ':. .:
<br />7', ~~
<br />, /
<br />~::
<br />~ r,±? .
<br />
<br />
<br />
<br />.
<br />REQUIREMENT
<br />...
<br />. "
<br />.. .. .
<br />" "' "' '
<br />.. .'
<br />
<br />1.1~:(71:
<br />
<br />.'..
<br />
<br />.'•{'
<br />r.n.
<br />~~
<br />
<br />:'1!. 'T.'I 'l.'1~.'Y~
<br />
<br />/I
<br />
<br />J
<br />"),: ?-.:l
<br />
<br />r SAMPLE -•r:O r:n1;1 •5 ~a;r rt r-:;c ~-Y::`{::•c': '1 ~:+: I;I;c r:
<br />( ~ ~~)
<br /> MEASUREMENT G~,';y t~ 1/r ;~ I(.J
<br />)l7':J :, I :~'.PERMIT.~.~ r',t r:k}'..c ~rt'9~ :~:.. iX"rihv~:;r :]
<br />Y :: {:;: j; !; ~, rl ft~:c':: " 'yr :}ius it;c;:. ./~.4'..
<br />-~ , ,..
<br />:r:Ll/h. ,,: ~•!, ~1: , ,.,1.1.1 REQUIREMENT
<br />~.. .'.. :' ~.: ~~ ~ ~
<br />.... ".
<br />'::~' . ~
<br />.i '•
<br />'t /r ~ ~ ~ ~~
<br />.,`
<br />JIL di~D l~!<J'ii! SAMPLE ,~:.r C: {c:f: O:F..^,:ie t`; ;c frt ye:•: 1 is I: :;>~,rri•y
<br />~IA ( 1 1)
<br />C' ,I
<br />(I'
<br />•
<br />~
<br />/
<br />~
<br />l: •,i)11 l~',: CD-I; It }. 'i °I"~I MEASUREMENT ;
<br />~ j
<br />.ni'1'_.6 1 (1 ll ~ . PERMIT... K:: 4Tt r}(:"
<br />' >3S<GG1: .xj
<br />~..'
<br />~~
<br />~ r,:icR r 4.Y: f,+t;a:: rt:'. ey,Y :}.;:'>y:': ': %t..11. '.
<br />~. •.'; G''i..i }i .: ti a r-
<br />
<br />... -,
<br />t 1~•,• B c
<br />}(:. (. :.',; ~. t:' ~ U..LU. EOUIREMENT
<br />
<br />
<br />R ..
<br />
<br />
<br />. ..'.. .~
<br />
<br />..: ~ ..
<br />~
<br />~
<br />.: ..~ '. ..
<br />
<br />
<br />,.::+p r,:
<br />
<br />..
<br />::. .~~. ::~.:...'~
<br />
<br />
<br />.:'T'1, i::T :;:;
<br />
<br />
<br />.rl
<br />
<br />
<br />.rT..
<br />,Lr', r ': .:/ i 'I L SAMPLE ,I,r i7 ft{I¢ '1; w:-•••'c y:>}io51yM - )
<br />~ ,; r}~
<br />( I
<br />
<br />(@:; ~_)
<br />MEASUREMENT
<br />(. •'.
<br />!
<br />l~ ~ - (
<br />' /
<br />(~1
<br />11:; ~, ] i (: U :'.'PERMIT ~: : r7 Cc:j ~ri. ~~r: re fk ra •;41p~1~
<br />.
<br />~ `I°~. :r S: ~e:: YO t;i rt>l
<br />
<br />~
<br />~ :3:.: .r:
<br />....
<br />.
<br />:: 'rj :.~~,n: ~ ;i~..
<br />.
<br />~
<br />.
<br />1 i::
<br />"~i
<br />I.., , ... 1
<br />..-U C, f;'f l~ 1tC,'::~ v A {. 17 . R.EOUIREMENT
<br />... .:: .......
<br />`.~." .. ::. '.. .
<br />.
<br />.:
<br />..'
<br />rtr. (
<br />..
<br />..' .:
<br />n.n.t
<br />"~5.1'C;..
<br />.
<br />:.'r';:A.7:1~~~:
<br />(..- / :
<br />t.•
<br />.
<br />`q ~-f, ~
<br />.
<br />
<br />r L,.t~, 1'i CJP L'.!; :' r: If
<br />SAMPLE
<br />
<br />~
<br />p;
<br />,;: tt,::y:, 1;: :} 1 j:5 {i'n:: i ::: C::: `::':
<br />
<br />~'
<br />,
<br />I
<br />'h.t.! '!'i'.''n'1'it E';r !'LA!:'! MEASUREMENT Qro-(-; t,•, ~4. ~: I
<br />// !.
<br />,iil„p i U '1 ::~ ~PERMIT~ :: ~. :)1'TSDt .4 L: ~.~:~ :..~.. fig?O.A:T G'"<IX rr fit:?::
<br />~
<br />' s: r,: 1:115 t,a:~~:
<br />'
<br />: -:c r~:;~;: <:: '.. ..
<br />!,.
<br />. p;.~~y ~ ,i„T;:
<br />t'F:.ili:f.:' C•i'I-:~•S l'Rl,!I° REQUIREMENT .''34DA~ 3Y•+ Gr1I1,Y •'iY" !^.~GD
<br />.
<br />~
<br />'::~.:
<br />~~
<br />.
<br />:.
<br />.
<br />
<br />.
<br />...
<br />, .
<br />~~i:i: FSr 'i'i.'Cr:. SAMPLE .7(7:5 Cc w. r. Y,r.1{:.+:a ;c 1;: ;:r{r.? 1;:;1 .•1 :.,y (
<br />'1
<br />.1) .
<br />'
<br />c.~, ~ 1 , MEASUREMENT 'I ( j(" (, .
<br />•
<br />-:i ( _
<br />1
<br />, , .
<br />L i,
<br />(
<br />111 "%'; 1 1, it
<br />-, ~~ ~ PERMIT.: ..~...',:!, 15 ir,p C~:.-' '. ~i~:1Orx lk l;c 'r, : ^.•0
<br />:-
<br />.t
<br />'rS'~" esi 15 Y;. '.Yi ::: 1: S,ti .c.
<br />
<br />.:.'~•':
<br />
<br />~ „).
<br />
<br />
<br />..
<br />. :•i•l.L h. I, I' iih(/~': .,r 1. (11 REQUIREMENT.. ..: :..:: ~~:.:: ~: ~'...:: 1"~: ~:: ~.' r: rcr.n
<br />~
<br />~
<br />~
<br />~ •:~. ~-+y~.
<br />~^:a~: a /1 ..
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENKTY OF
<br />AM FAMILIM WITH THE INF0 lAW THAT I HAVE PEftSONAIIY E%AMINED MD
<br />11MATION BUBMITTEO HEREIN; MD BARED ON "~
<br />~
<br />"~~
<br />J TELEPHONE DATE
<br />_ MY INDUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATON, 1 BELIEVE THE SUBMITTED INFORMATION IS
<br />
<br />'
<br />
<br />
<br />' TRUE, ACCURATE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIHCANT PENAlTIE9 FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING - J~ ~! _
<br />•~ ~~Ax '
<br />' 1
<br />~`
<br />~ ,
<br />T
<br />E POSS
<br />LITY OF RNE MD
<br />MPNSO
<br />MFNT
<br />SEE t8 U
<br />B
<br />f 1001 MD ]]
<br />C 1 ~J ~'~ ? (t
<br />~
<br />" ~-
<br />~ t I
<br />_
<br />;;
<br />; , ~ , 1 ,~
<br />' .
<br />.
<br />.
<br />H
<br />IBI
<br />I
<br />N
<br />. 61 ATURE OF P111NCIPAL EXECUTNE
<br />A ~
<br />~
<br />J 1 `~
<br /> U.S.C. E 1 ]le. Ih,WW. 1n0.r erw mrons nvy I`rA.W rANa W ro 710,000
<br />TYPED OR PRINTED wor nt..:ts..r tttwwnt.etraae.wtemenm. rlCe Y..n1 JOfFlCER OR AUTHORIZED AOENi coDE NUMBER YEAR MO DAY
<br />COMMENTS AND EXYLANA 1IVN DY ANY VH)LA 1IUnS IHerBlenCe e// BTre00Tenrs nets!
<br />;!:i": L it%:-l'. '-!TLC's !.I'.T?' F.ppL7r.S ONLY IF C= 10-YRr '0-RR ?k!?CTP 'F.VFPT I3 C1.ALKF"~. '" r-; •I,. ct:p~nl'h;~ PY
<br />„_,i: !;, '!':;:: lic^:. Li"; ^.''' u11. ;. SOT H'r; AF'PLIi'.G TO ~F.PONTF.D I: !'ASURF.MF-HT~- -SrL: •.n.l 8r ;~ 11 ~:;~ r.t~. i(', !~ .
<br />}PA oiin 3 0=1" 108-951' Previoub editions niey be"u'sed. r (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE OF
<br />
<br />
|