Laserfiche WebLink
•ERMITTEE NAME/ADDRESS l /nrlude <br />l.u iliq A'anu•/L Brafion i! dillerenU [ ~ ~~ <br />.r.DORESi-1~1-lIL YIa ~~S-7.~ _ _ _ _ _ _ _ _ <br />I ACILITT <br />_ - _ _ _ . _ <br />I OCATION <br />_ _ _ _ _ _ _ _ <br />L lr'irn C~i G eTl[TS :rl. <br />NATIONAL POLLDTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT / DM11R1 <br />(?-I61 (17-191 <br /> <br /> <br /> PERMIT NUMBER RISCRAwcE Runecw <br /> MONITORING PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />FROM 'J l; :~II :, ~. TO .; .i rl (, ~'~ <br /> /]0.]11 /~l-?il I'4JT1 /76-771 I>R-0-I lilt-ill <br />MI'n~R <br />t~ - F I !i r1 I. OMB No. 2040-0004 <br />:! t: S T i I T S F.'APpro~t~explf1s ~p1~I~R C R k <br />;'';an tlla IISCR,A,fiG'r. ~ +''~'y <br />NOTE: Read instructions befor BletinQ this form. <br /> (i Carl Only) QUANTITY OR LOADING (4 Card Onlyl QUALITY OR CONCENTRATION <br />PARAMETER (46-51/ (54-611 (18-4J1 <br />46-53 <br />54 <br />61 NO FRE OUENCY SAMPLE <br /> ( <br />/ ( <br />- <br />) . <br />l it J]/ EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> l6ldJl (618) lb--701 <br />I: .IL iihl°. ~.~. E. SAMPLE :es: eF :4 Y::3 ( Cs (l~ o:: {c r;ns .',: ~, ,::;a.}.;: rf Y. ~: ll it {: (: <br /> MEASUREMENT <br />. I, ;, L <br />I •(Ia 1 ~ I.J PERMIT ~##b40 ) Y ES=1 YFIEIKsW.+*G CtfF~:i}Qllp gY,'L[s:}Z: ; :: (s :;: EEKLY ISUJIL <br /> REQUIREMENT <br />~S ~, 1 ._ I f: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ' <br /> SAMPLE <br />~ <br /> MEASUREMENT _. ' <br /> PERMIT ., ~~ '~ ""Sl ~ t <br /> REQUIREMENT ~ .. ~ ~ ~ '~ <br />'' .. <br /> <br /> SAMPLE <br />MEASUREMENT _ ~ ) <br />I <br /> 1 <br /> PERMIT ~ ~ ~ ~ ~ ~ '~"'^" +~ <br />) <br />' REQUIREMENT ~ ~ - ~ ~~ s~' ~ ~ <br /> <br /> SAMPLE •~ ` <br /> MEASUREMENT ~ <br /> / <br /> PERMIT ~ <br />' <br />- <br />~ ~ ~ ~ <br />~'I'" ~ "' 1 <br />/ <br />~' <br /> REQUIREMEM ~ ~ ~: <br />~:, <br /> SAMPLE ~ _ ~.~ <br /> MEASUREMENT <br /> PERMIT - <br />.. ~ REQUIREMENT ~ ' ' ' <br />NAME/TITLE PRINCIPAL E%EGUTIVE OFFICER I CERTIFY uHDER PENALTY of LAw THAT I HAVE PERSONALLY EI(AMINED TELEPHONE D A T E <br /> ANO AM FAMILIAR WITH THE INFORMATION SUBMITTED MEFEIN. qND BASED / <br /> <br />R <br />G <br />ATKINSOPI ON MT INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTPININL THE INFORMATION I BELIEVE THE SUBMITfEO INFORMATION IS <br />~ <br />' <br />3 <br />4 <br />U <br />. <br />. <br />TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE _~ 03824-0451 ] 7'iT <br />VPIAND/ENVIRONMENiALAFFAIR~ TI~iEFPo55BILTVNOFIFSNE~AND MPRISONMENT.SSEEFIBUS«i IOOIIAIND SIGNATUR O P INGIPALEXECUTIVE <br /> 33 u5C f 1319 fPenalues unJrr these sW(ulas nuY [IuJC linen up In AREA <br />TYPED OR PRINTED f/00W unJ m nusrmum imprrsanmenl a! bnwrnn 6 mumhs and 1 leas) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (Nelerentt all auacnments ^ere/ <br />!'7LEABLE SOL7DS LIrI; APPLIES Gt:LY IF C= 19-Y~, lu-H6 P"nt:CIP EV°N'I' IS CI,AIMFU. 7F CLAIM APPROVED BY I <br />~•.:(., T55~~ IFON LIt]ITS LILL t. 0'C HE GPNLIFL TO !iE['OF~G hEASUiIFM°l7iU--SEE i.1i.1A, PG 4 AND I.B.1D, 4C 6. <br />P/BViOUS BdlfiOrlS II12~ bf uSCd. IREPL ACES EPA <br />MAT NOT BE USED.1 <br /> <br />OF <br />