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RERMITTEE NAME/ADDRESS /lnrlude <br />F~rillry NerQr/ prulnn i/ di~Ye(rnl~ <br />NAME 7 l~M1 . A '1 I I I Y .. - n ., : ~ ~:.:' ; r ~ <br />ADDRESS ~S`-11___ .1~1+- I--+1`___-_-_-__ <br />__ P.Q. I I? -------------- <br />FAC_L?Y- ~L~~_/~.~L_~_/ITrU ----_-_-_-_-_-_-_-_ <br />LOCATION - ~Y`- =t>f ~/I/C _ _ _ _ _ _ _ _ <br />N1.TION AL eOLLUTAN] DIICMARGE ELIMIN •TION ST.TEM f NPDES) <br />DISCHARGE MONITORING REPORT (D.NR) <br />(1-l6) (IJ~I91 <br />PERMIT NUMBER olec...Pe w <br />MONITORING PERIOD <br />YEAR MO DAT YEAR MO DAY <br />FROM ~, ~,L TO ~ I <br />r+l4lll rr]-0!I r>d.151 !)e-)]I (]R~)91 rib 111 <br />(; ' ' "~ . ~.; I Form Approved. <br />- ~' ~ ~ '(; OM8 No. 2040-0004 <br />I -. - u q , ~'Ayprovel:e%ptre>f 90.9'14 <br />NOTE: Read instructions belo completing this Corm. <br /> (i Ca r4 Onl)'1 QUANTITY OR LOADING (! Card OnlYl QUALITY OR CONCENTRATION <br />FREOVENCr <br /> <br />PARAMETER <br />(46 ~SJ) (51-6/) p c <br />(.8-45) /d6~5)) (_4~b1) NO. <br /> <br />E% <br />o< SAMPLE <br /> <br />TYPE <br />/i?~iJ) ArvALryS <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS 1e_b11 ) <br />re.~f <br />revaor <br />Yd .. ,+.:.]:: :fit: .. ... ( ~) <br /> SAMPLE <br /> MEASUREMENT <br />~ t ~ <br />004i .. .. .r L r -. b, rtbtr6CLil q.0 F.FKLi kAr? <br />, PEPMIT <br />r.FPLIt'li° dJi_° VPi,.. REQVIREMENT ce`:: ,yYNIMOM MAxi (1h i_' <br /> I.. :.. <br />- SAMPLE <br /> MEASUREMENT <br />0^;45 J ~ `• •' "?':rs-' + ''' ara•fP = 0?TIOHAL u. 9CE/ RAH <br /> PERMIT <br /> <br />~.Ft 1.7~:Iir 'i i].`. ~.1 .. ': <br />REQUIREMENT <br />:':}<.: Il <br />30OP AYo <br />DAILC SIX <br />"i 1./.. ~~11 <br />~la"tLH <br />-.,~ <br />' ~ ( <br /> SAMPLE <br />P r4 [ (' ~ '. ~'. i " - .~ V. A V ` MEASUREMENT <br />it i'] '` 1 ., •"e?" :. .. O I:I } C171}?'.'!' GChptl' t\ <br />~ Ot1TI7o+ RAH <br /> PERMIT . <br />~FFL'JSwi ,3; 5; YnLt' REQUIREMENT " INST nAL "'./'. GF.R1 <br />Li1~ <br />h ..vNU ri JA ~ '.I) '`I:-`.: :':: :: '3i. '. ~.. <br />4 SAMPLE - <br />1'HkU TRI: ,1ir3 :.vi PLA~IL MEASUREMENT <br />i00~'J 1 (i G F: f' R 'r.UIT I o ur, aunaaa aaaar:~ :. .. rF,P.LY 1lST <br />AM1 <br /> .PERMIT . <br />- <br />CPPf.IJ~Nr J:i,GS J.A .O' REQUIREMENT ~. L)A AYG DAT~.Y Mx V„il <br />i tL <br />.JJL '~ r. .. Yi :: ~::^.j :: .:<~?~: ~: ~•. ( 7 1) <br />• .. SAMPLE <br />i J •~ nI Y ;; •) MEASUREMENT <br />7~1')~ 1 0 ~ o la.,vav a'?r aaaos;: OPTICRAL R''i'OFT TRLS &1}B' <br /> PERMIT <br />3FFL7E!tT :~n~3; Vq:,'i' REQUIREMENT ++':LF:: QRTP AY, JRTR. "AC './I. - <br /> <br />'.) +~ I' :. ti ~ <br />SAMPLE ..... <br />_. ~ ;..I ,..:.,... <br />.. <br />Y 1.~ (~ AL MEASUREMENT <br />5uo66 n ~ r,~ 1 , L,-; u o., ~Q~ aaha~,u ~. eeRL I <br />SUAL <br /> PERMIT . <br />E F t' L O is 'I L . :~ 1 -> .] Y'+. ~. - REQUIREMENT i q ~, T ~ A X - r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ .`~,:. . <br /> REQUIREMENT "' - ' <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERnFr UNDER PENALrr of Lww TMAr I HAVE PERSONAUr E%AMINED TELEPHONE DAT E <br />,~~ NDNM F.MILI/.R WITH THE INFCRM.TI(.YJ SVBMITTEO HEREIN ANO BM1SEO <br />Dry Y ryOURr QF THOSE NDIVOUALS MMEDIAiEL+' RESPONSIQLE rOR <br />c <br />ATION I <br />TT <br />R <br />D ~ <br /> Irv <br />M <br />OBTAIrvING THE INFGgMATUN ~ BELIEVE THE BVBMI <br />O <br />S <br />E <br />TRVE .000RaE ..NO COMPLETE I AM AWCRE TMa THERE aRE <br />O~ <br />4 <br />~ /} <br />(,~ <br />/ <br />F <br />V <br />~ <br />R f NIF101NT PENALTIES FOR SUBMITTING. F1LSE INFORM<TION INCLUDING ~ <br />/ 7 <br />-/ <br />Q <br />G~ <br />~c~/-s4n ~ <br />~ n+E ROBBIBLIir of FINE AND IMRRIBONMErvT SEE la UBC 1 IDJI AND <br />l <br />d <br />G <br />r <br />ln <br />h SIGNATUR OF PRINCIPAL E%ECUTIVE / <br /> <br />TYPED OR PRINTED u <br />r <br />nc <br />u <br />v under t <br />at fnmra meY Inr <br />]] uBC 1 I]~9 IPcne <br />flOq"U .nJ or m.nmum ~mpmm~menr a/ nrmrrn 6 momN enJ R mn I <br />OFFICER OR 4UT MORILED AGENT ARE4 <br />NUMBER <br />YEAR <br />MO <br />DAY <br />:OMMENT AND E%PLANATION OF ANY VIOLATIONS (Re@rcn[r ell e!!e[h]nrnre here) <br />7IL (, ~E ~n it-' ~.. 1:''C T,. :/ :.°-.. i.. ."- .. .." .. .."_ ., le' .= -r"r +.:- ~~+.C'r :, <br />~,ve~lr ~LO.r~,F:n. <br />PA Form 3320.1 IRev. 9-89) Revious edrtlons may bE Ibefl IRE PLA CES EPA FORM T~40 WMICM MAY NOT BE USEDI ~ / ~ I, I - PAGE OF <br />