|
PERMITTEE NAME/AODR~SS pweidrF«WryN~w/L«.rlen 1/DIO~r+nr)
<br />NAME (_i ~ :~ l..i'a , ... r'....`'~ ::' . ' ___...
<br />ADORESS;_,:~!.'y1,..,.i't1',4 ~Fi~+. `~•_. %.t._i'~. ' ,. ~:.t~;l;_"r.
<br />
<br />
<br />FACILITY L.`i'~ !' ... '? t.~til~. °: ?~~?~. : ! , ~ :~.'.,~ hiL=~~
<br />LOCATION"74 `~~~!` _.r-<' `,:. ~. ~~• l.` r_i ., t t."~ ;_~ x~.
<br />+-t!";'i`,f. y.l:~,i'Ftt^c; T : _:riF'.;-:'.i=.:. ~._..,.-.(.: r,. i1.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESJ
<br />DISCHARGE MONITORING REPORT /DMRI
<br />PERMIT NUMBER ascNAROE NuMeER
<br />MONITORING PERIOD
<br />YEAR MO DA YE R MO- DAY
<br />FROM ~.. _ ~:., TO ~_ , ...-
<br />Form Approved.
<br />tyl ~ r t a ~•y OMB No. 2040-000d°
<br />NOTE: R~~d Imtructlofa b~ttx~ colnpbtiny this Iwm.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br />
<br />EX of
<br /> ANAtvsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br /> SAMPLE
<br /> MEASUREMENT
<br />. .- „ .,
<br />;'t : P~ )~.i ~ '.: t_,
<br />PERMIT ,
<br />~ .._,.>• .,.
<br />~
<br />,, ;r-;< -~ , _, -
<br />~ d•a
<br />=
<br />, .
<br />, . _ o..
<br />~ .a ... .
<br />~ , ',_s,.~:_?' i f+')t.d~N.7 `='~,i...t~ REOUIR~MEN7 .... ~°: ~ t ,:~~"';t_J1'' , „'~ _... t`' ~.'-,"'; ::21
<br />= i`'If ~C~~l'i-~.,
<br />,:1 ,y,,
<br />SAMPLE -
<br />-~, -~ ~'-, >: ;;
<br />, ., „ ~ :..
<br />-
<br />:-.. ,. -...:
<br />~. .. -.
<br />~
<br />...
<br />t_:;-~;-" ~:: !•, C} Y's--; MEASUREMENT
<br />_ __._ ,
<br />
<br />,.
<br />i ~C')'~;,~t? ;. t. '~`~
<br />.PERMIT:..
<br />..;~~ a ~:.
<br />•z•. .. •..<r,~r
<br />.-
<br />~ -. ,~.
<br />_r,
<br />..
<br />, .._.
<br />.~.:, ._~
<br />L. ~ ~ ' did-'tyi-l. ,~`F ,. _. , / : 1 i 1 '
<br />. ~_ .,._, _ . ,..;~, ~ .,_...
<br />REQUIREMENT. , ,. , .... - _ _. ~t~
<br />' ` , '{ ~.
<br />~
<br />``~r;t~' i l
<br />I ,., a
<br />::~t .. ~ ._ ._ .- .. SAMPLE ~' >.- . -. - •r .a .. : , ~ . _.~
<br /> MEASUREMENT
<br /> -
<br />_ .,
<br />i;,r` ,~#' t. PERMIT ,t , ., ,.,
<br />:.. _ .. .. _ ._ .......
<br />~'.f f` 1,.~.1<::hl ( r~:! ,.t~:M ~`t=?1. ~ 3~ REQUIREMENT- `.. ... .~+'L~e= .'..: .r`~:'f'. ?' s t._i ?_ f'll~}'v t
<br />_._.n,: .a -:r,.. SAMPLE
<br />- -•
<br />;r.~
<br />i ''~:~: '- 1:. ~' MEASUREMENT
<br />
<br />_
<br />
<br />..
<br />-
<br />- -
<br />-
<br />_ » ..
<br />._ ,.r
<br />'- } >~ PERMIT' i ,,. ~
<br />... r ,."~ _, :: ~ ~, ~
<br />,, ,, _ _.
<br />;:~.3 ~_', i~€y :` - .' ... --a ~;'f~L..4; )4 REOUIREMEN7
<br />_ R 't ,t.~a.lr~ , ,' ~z ~?r~ !: i _ ;~ ;` ; ~; rN r` ~.. t~1~1`.("'`t`
<br />n ~ ,.,,I I SAMPLE . -
<br />
<br />,.
<br />_
<br />..
<br />.. ..
<br />.,
<br />
<br />_
<br />r .7-
<br /> MEASUREMENT
<br />
<br />?...~...,~..' ,. {!
<br />>'PERMIT . _.,
<br />~"
<br />-,-., ,.,,
<br />.. ..
<br />r,. ,. ..
<br />..
<br />~
<br />..
<br />...
<br />x~' t,i~A~i ~ ~>~~' 3:..,., ~~=.:1 :,t~ REQUIREMENT .. _. !~ ;mil,: ~ i'(~~ i ~_ ts`~~5'~`r
<br />,_ , ' '..
<br />_..11 ~. ... - SAMPLE
<br />
<br />,... _, .
<br />~ ` . -, .. .. ... ......- ... .
<br />E~~`.N>~ ~`t~~~.1-I'iL.`i~4~~ i~f._sa;~•~~ MEASUREMENT '
<br />
<br />~ _,
<br />_
<br />.
<br />,
<br />:~~ ., wC.;+ ~. ii '..
<br />PERMIT
<br />r~. ..~t~. ,
<br />,., r~
<br />,-,- _ .
<br />~. ..
<br />.:~~
<br />,.,..,a_
<br />.. ~ ..
<br />..._ .._.. r~„~.....t ~ . <i..~1:_
<br />'-~~ ° Lr•_~~,;~ I `f- ~.~ yJ•i ti R~QUIREM,~N'r
<br />io" 7:
<br />-~c:~~z~: ~ _
<br />~ (_ ~~'{
<br />~., _.
<br />~~,
<br />~
<br />.; .~'.•'r:~,.
<br />)"Il,.)I~u i t
<br />:~ ,...t. ~.` , t ~ .. SAMPLE
<br />!.? ;'?=~=;~It_4?~i~ MEASUREMENT
<br />_..
<br />- .. ,
<br />~.
<br />,
<br />,
<br />`~ t..'. =)'~ !~.-~~ .~'~ ." .,i... REQU{REMENT ~ r: -Ti's. ,~ tt„ Fa `~ .: F~ J i._'Y hi X 1` ~ ! f _
<br />TITLE PRINCIPAL EXECUTIVE OFFICER
<br />NAME ' """y ° er pens ty o bw tnu Ihla documem sna nu ~etnchrnenu were TELEPHON E DATE
<br />/ prepared under my dlrertlon or super.glon In otawrdnnn with . system desi`ned
<br />~
<br />''T •~/.,
<br />J (+ t ^.•~ ~"~ I • to tenure that queHfled personnel P~dy ether and eedusle the Inforenabn
<br />aubmltted. 6asM on mY Irpulry of the person or penoro who nuns`e the system, ..-~ /'
<br />~„ - // i y
<br />J ~
<br />~ ( G'y
<br />~
<br />~~'i~
<br />~
<br />~
<br />~
<br />or thox persoro directly rnporolbk for ptherltq the Infornutlon, the Informstlon .
<br />j
<br />CEY
<br />!
<br />t ' - ~~ ~ `~~~ ~~?? ~ ,
<br />(.~~? t >~~'-
<br />~~ G
<br />~'
<br />~
<br />~ ~
<br />~
<br />
<br />~/r'(' , ~ ~\ ~ r'
<br />7 //
<br />V
<br />submltled b. to the best of my knowkdNe and beNef, true, sccunte, and mmpkte.
<br />1 nm swsnr tknl there nre sl~nlflunt penNtles for submllNn
<br />fdx Informstlon
<br />~
<br />EIONATVRE Of PRINCIPAL EXECUTIVE ~
<br />„
<br />.
<br />I ~~ [ Gs
<br />C
<br />TYPED OR pR~TEp ,
<br />N
<br />Inclualn` the poslDlllty of ene end Imprltonment for knowlne vlolstlo~ OFFICER OR AUTHORIZED AGENT CODE NUMEiER YEAR MO DAY
<br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS /R~f~r~nc~ sl/ arttachm~nts h~rtrl
<br />:3 ' __ 1. ~ i ~,."~5 -
<br />,~~"~Li "'t ...'a.'•i_ .. ,., i. t. .!:.. ... T>._ .r,... ... .. .._ ,.
<br />'~1 ~-~ ,.:yl ~l
<br />.-..+_s.s._ ..
<br />F'«; .1 t R. ~~, tl .i- .-.y.
<br />,_.l' _.-~..;J ut~
<br />..~ ~ r"`Y lrp,...p. t
<br />-. .~.iµ. _. .. :r; :,.rt.
<br />1.
<br />~b.._.i,
<br />_,
<br />=:, ~ i j t- ^~t_.~"f.~t %_„ii. !~ i''iN3~' ._. iti~? °a: :;. _,`r ..rrT°,''..
<br />,~. _ , ,_.~._... _.._ 1`
<br />._! tii_. «_b ...^r
<br />t
<br />y.....~_ .... .,. h~:~ ~"~,
<br />r.Ti)i a.. .r. ...s i~ :s
<br />?=Qrc ~"::~
<br />.. 1 _ _ ._.. n _. 'f •'; -.:'
<br />-,.r--~ri~i ~ "~"'^ ... , , ~ t , t~ e- 'l k I F=~ ' 't _!: [
<br />,... E t P.. --1 'i: t i t-!rl _ij ~(
<br />~ i i" j "r.i J ! ( y {.. •. ~ ~ -
<br />y ~ -' t ` A. ~ {. ~ i
<br />'
<br />,
<br />v
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. - r" ' T~11 4 t
<br />• PAGE yQF
<br />
|