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PERMITTEE NAME/ADDRESS (lOdudC <br />1 arilil) Name/Ln[alian i( di?mrnll <br />WANE _ `a, a-i.ll-D -,; L'-i fl. -~ L`-Sl '~.c~l.'4- - - - - - - - - <br />ADORES <br />FACILITY <br />_OGATION ___________________ <br />N I': <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPD(:S/ ' <br />DISCHARGE MONITORING REPORT ! DM11R/ <br />(?~I61 117-19! r. <br />I1+il„ <br />. - - . ~ (S L ~u F L Si) Fprtn.Apirroved. <br />PERMIT NUMBER ol.cnwncE nul.e¢n t - I I IJ A L OM6 NO. 2040-0004 <br />MONITORING PERIOD A ~-- i i' I ~I ; F. Imo. Qrovallfex{riFes ,IOd3i1L~4R C R P <br />YEAR MO DAY YEAR MO DAY <br />FROM ./:t 1`r '.,~.. TO r~U /.~ .: 1. ll:i:~ 810 DIS~N~RGE (~ ( Jfii: <br />r?n-?u r'?->u N{ 'sl rab~?n t?s-19J r-+o-r!/ NOTE: Read instructions befor pleting this form. <br /> !3 Carl Onlr) QUANTITY OR LOADING (.! Card Onty) QUALITY OR CONCENTRATION <br />PARAMETER ({b-S.i) (S{-611 (J3-{fl ({6-5-U (5{-bl) NO. <br />EX FRE ~ENCY SAMPLE <br />TY <br />E <br />! 1) J7) gNALY515 P <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITE dldl 70 <br />6 <br /> l <br />l lblb8) ) <br />l <br />9- <br />... All L/ fiL f.~S `. SAMPLE v1s ter'}•: ..~ ~ '~4) :.4:;: {: ,:.C r.. s::~Q{:'.I Y: <br /> MEASUREMENT <br />I .~ L A L <br />~~ (t 1 ~' l~ PERMIT bC•^•'}:}•'.: J Y :._=1 t,„'IV:{IJ"} 'mot Y,: {r.•,:'r f}y:Y: tf 'v~ Y, +: Y}K: <br />€EKLY <br />ISDAL <br />r r. / I REQUIREMENT OT it - ^lIKIfi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "~ ' <br /> REQUIREMENT - ~~ ~ ' <br /> SAMPLE <br /> MEASUREMENT -, <br /> PERMIT - ~~ <br />I <br /> REQUIREMENT f^r ~ <br /> 6AMPLE <br /> MEASUREMENT ~ ". <br /> <br />PERMIT <br />~~ ..~ <br />~ ;? <br /> REQVIREMENi - ;j '; <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT <br /> REQUIREMEM <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERTIFV UNDER PErvwLTr of LAw THAT I HgvE PERSONgLLY E%AMINEp TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION yJBM1TTED HEREW AND BASED q <br />R <br />G <br />ATKINSON ON MY INOUIRV Of THOSE INgVIDUALS IMMEpATELY RESPONSIBLE FOR <br />NG THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION IS <br />OBT4IN ~ 3D3~924-045 <br />vV <br />. <br />. I <br />TRUE ACNRATE wN0 COMPLETE I AM AWARE THAT THERE ARE 95 <br />0 1 <br />` <br />'I /~ <br />` <br />I <br />VP LAND/ENVIRONMENTALAFFA.R' SIGNIFICANT PENALTIES FOR SUBMITTWG FgLSE INFORMATION. INCLUDING <br />THE Po551BILlTV OF FINE ArvD IMPPISONMENT. SEE IB USC. f 1001 AND <br />SIGNATURE OF PRINCIPAL EXECUTIVE v <br /> <br />TYPED OR PRINTED 33 UBC f 1319 IPa~ndlek. anJU Ihc.c slawl[s m+)' OrluJe Irno up fn <br />fIOfXA'1 anJ ur nu limmn ulrprironn¢m m hrrwe[n n Imrmhs unJ S )ran.l <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />~ DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS !Rr/?rcn[[ all u((a[hmm~fs here 1 <br />..I'ILEAfiLE SGI,ICS i.I!1II' APFLI25 ChLY If' i= L6-Yit, c)1-;([s {'i LOIN £Yi:Lf IS CLAINEL. Ir CLF.I!'1 APPROYF.D BY <br />. ,:'LI, YSS f, ILiGtt LI°TTS RILL 1iIjT i.C AFf-LIF.f. ::i acl•n;;li~l :'Id~IJi:ECE•.:.TS--56i I.L.lll, CG 4 P.t.D I.B.1D, PG 6. <br />EPA Form 9920-1 (RBV. 9-88) FIQYIOUS Bdl!lOlIS ?IaY t)B USCd. IREPL ACES EPA FORM T-10 WHICH MAY NOT BE USED.I PAGE OF <br />