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rrtt N.Mtrwoowtlf (1nL11Me <br />.Y.TI((.O[Ilbw IJdi~flfnf/ <br />E.FA.Bt1DLyJAL_CD_ i-+P.-N ~>~ ~ NE y~ <br />xn139~~-~SH~AL~ -- _ ---.-- <br />-£LA GSSAF~__- _ - - ~ Z_ fly (LO L_ <br />'ION <br />1;• IlllNa Lfl A_ 7.OLTfN -------- <br />N.TION.LL rOLLV T111[T OIlCN11wOE [LIY 'NATION [r!T[M /NPDESJ <br />DISCHARGE MONITO RINO REPO RY (DMRI <br />l~/Q/ 1~70~/9 -y~ <br />rEwMIT NVM.tR •.~J <br />fAONI70RING PERIOD <br />rLwR YO Dwr rEAw MO owr <br />rwoM To <br />RO LI /11~.!L 116131 /Ib. 1 118.?91 1 6 II <br />M I N O R Farm Approved. <br />(SOBR NY~OMR;gyTQ40-0004. <br />F- F I N A S/(PProva! expires 6-30-91 <br />NO PRFCZP.2LR-FLDf7E <br />= NO DISCRARGe ~ _~ ~~= <br />NOTE: Resd in3truction! before comPletinp Ihi! form. <br /> (J Card Only) QUANTITY OR LOAOINO If CPId Only) QUALITY OR CONCENTRATION (rILCV CNOT <br />FARAM FT[R (16.7)7 (S.dll (fdJ31 (.bJS) (Sddl) NO. <br />[% Dr fAMTL£ <br />TYP[ <br />(J2~J7) nLLYSIf <br /> AV ERAOE MAxIM UM UVITB MINIMUM AVERAGE MA%IMUM UNIT! <br />d1 dJ) <br />(6.6d1 <br />(bY~)D) <br /> BAMPLE 'SL(nrvYN[NA- OiN3O#? ( ' nFJ <br />I <br />S Q>rv+~.NArv o ~/ <br />~ ( <br />\ I2) <br />/ <br /> MEABUgEMENT • <br />T O. <br />T O f <br />?D I D D PERMIT S °' Q~+kiLwv .~i<$~v~, v(-'~ 6.J~ a 0 .(f•J~y#~ ~ 9.D~>.I eEeLT RAR <br />LOENT GR7S5 VALII REOUIREM ENT ~~S:S !1 <br />IDSr TOTAL BAMPLE <br />E <br />T Y#"'~r~r ~~t.'i>Qt ( ~ T'v$'~ aa <br />o a~ ( I9~ I <br />oENDED ABUREMEN <br />M . Io Q 3Q Grab <br />30 1 0 0 <~PERMIr ~~ ~ S: .tR3f~ Y34#>'s4 ;k?4 4C>k;3:ti ; .- ;REPORT ~~~`REPORT`~ HCE/' RAB <br />LUc'N GP.O YALIJ ReouIREM EXr ~~ _ ~~~~ <br />[DS, SeTTLF.ABLE BAMPLE #4rtL0 t#+-.. ( ~ ,...,_,-.. 3r,-r,• ( 25 <br />~ <br /> MEABUREMENT ~•df~ 0 ) Q ~~._ / <br />CLB <br />75 1 0 D ":LgMI;, t>xacaa <br />~ <br />~ raasaYa: ~ ,•r m.#~,<Ya~~ <br />~ ~~s~dar ; REPORT, <br />` ~ NCE/ BAB <br />UEN CROSS VA D RcomREMENr '~.=, <br />%. <br /> <br />~ ~~$ ?: a<,... <br />4' € <br />.~ .. ,. <br />J, TOTAL BAMPLE :dISSt#a aaa,.#a ( ) ~..,.-,. , ( 19) <br /> <br />(AS FF' <br />MEABURLMENT O.// D./. <br />~ 0 ~~ ~, <br />HS 1 0 D ~~~PERMIT=- a~rr+z#~. -~raaaa ,.,, ~ #4>Xa#'~, s REPORTS '`REPORT ` HCE/ RAB.'~ <br />I ^e D REOUIREM ENT .. ~/ :. <br />T ~ a .. .; ~ . <br />r[ IN CONDUIT ~R MEABUREMENT O <br />O~ .~LL <br />0 D3~ <br />( ~~~~~~ ~irvYr w([vv YY ( ' ' <br />~ <br />': TREATCI F.NT PLAN . <br />t% D <br />• <br />T 0 n5 <br />~D 1 0 0 MENMI* 'REPORT+• OPTIONAL: #~'a-~~' ~=aaa~' =caaar. o,•,, eeeLT NST$N <br />r Hr - RCOUIwEM EMT q <br />~.~ <br />~ . <br />..~ <br />IDSF TOTAL BAMPLE <br />MEABUREMENT ~~$~- ~al~'N`•~ ( ) "~~~ 3 3°98 <br />~ ( <br />19) 1 <br />~ ~~ <br />~OL9ED oiq, • Q O j <br />!S ~. D O PERMIT' O'-FL`~XG'i'.. <br />' ~L$vrIISL `v~~ /[.•[~~T,~Lh' <br /> <br />OPTIONAL` <br /> <br />..°RFPORT <br />~ <br /> <br />TRLT <br /> <br />8AB :' <br />SUENT GROSS VAL REOUIRLM ENT - <br />~ w ~I. 44#~ ~~ ~ - . <br />AND ;REASE BAMPLE <br />MEASUREMENT ~ O4SR-. ( gq) ,.#a:,• t: fi3: ..,.#4LTr ( ~ ~ <br /> <br />.~L <br />/ ~ <br />J <br />I S. <br />'5 1 D O PEwMIT REPORT 'aa~#aa ES=1 ~O'k?~fi '-~~^at. `-~=~ -- <br />~~~ EERLT ISDAL <br />I REOUIREM LNT .Yp. .t ~ <br /> <br />V <br />hr . <br />)TITLE PRINC VAL E%[C UTIVE OFFICER I C[Rlnv Vnpfn eCN4iv O[ LAw TNa i pC r[pyJNAL1v [afYm[D <br />•MD IY IAYILIAR wITN TN( IY[OpY.fION SUBYITILO w[p[IN AMO BASLD tELEPXONE D A T E <br />/1 ~ ~ ON YY INWIRr O( T•q'E INOIYIOUAL$ IYYLOAf[LY R[SIONSIBLL /OR <br />'LV\ r Un Q/ OBT• mG iME M[CR Y.TIO.V BLLI(V[ fYC SUIMITT(O N[OPYATIOM <br /> <br />^ <br />` <br />~ I$ fpUC fCCUpAiC .iNO COM.LRC ~ /Y .wAp[ [NAT TNLR[ •p[ $IG <br />YTkAni RNAii~[5 fOn $u9.RING IALSL IM[OpYATpN ~NCLU VNG <br />' <br />G!\~1/O A 1~ <br />nmtm~ I <br />~/ <br />.~ IN[ <br />xY51B~L~M1 O[ nM[ Ab0 IYpw50NYCNT $E[ ~B v5C 1 ~OOI eND .I <br />l <br /> ' <br />IT SC \ IJ19 •Pm•b... .M.r iArr vine no .nrlW / <br />In~u~. BIGN ATURE OF PRINCI L E%ECUTIVE J <br />a .~,3 <br />Y- <br />TYFED OR PRIXTED .n.• ./ n <br />n•N..rn.Nn..n ~n n•..nvn...I I.IY..n R.r.•nM. •nl i.rRr.. OFFICEq OR AUTMORI2ED AGENT ARE'( NUMBER Y[Aq MO OAY <br />.•~ wNU L.IL.N..IIVN Iar nnT YI~~.IIVna In~IT.•na• nN YNUa rrm.nN n••.1 <br />'~7 DISCH.A RGP. 7000 RS REPORT "NO DISCHARGE''. OIL AND GREASE (OSG) -- IF A YISI3LE SRe?N IS DETECTED A <br />SAMPLE SH4LL R? COLLF.CTFD AND ANALYZED FOR OEG. REPORT SAMPLE 3ESDLTS AS AV ATTACHt1 F.NT TO THE DMR. <br />T o-r(.[: R ND eO~ ! D$ , .([ .O T.. ION T [ [ ~~ ____. ._._._. ._._ .•DE D. , <br />'~ <br />C <br />I. <br />1 <br />1 <br />1 <br />J <br />(A <br />I <br />J <br />J <br />J <br />e <br />J <br />J <br />