|
PfRMITTEE NAMFJAODRESSQ~i.f.rrhryN~./l.enrrwt/D(Qt..wu)
<br />NAME ,~
<br />ADDRESS t.'`~11.JY~1 ~iiNr
<br />{ c, -. A 7 ;:- N I C' Hi,~l r~Y ! ,=i
<br />~_'•WYU Pi I E~i,P
<br />LOCATaN ,,ER 8
<br />NATIONAL POLLUTANT DISCHARGE fLIMiNAT10N SY4TEM INPOES)
<br />DISCHARGE MONITORING REPORT IDMR)
<br />PERMIT NUMBER ascl+Aaoc efa
<br />MONITORING PERIOD
<br />YEAR MO OAY YEAR MO DAY
<br />FROM To . , -
<br />Form Approved.
<br />OMB No 2040-0004
<br />NOTE: Rs~d InstrucLloM b~l«~ compiratk-g ihb lam
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
<br />
<br />EX FREOVfNCY
<br />OF SAN
<br />
<br />TY
<br /> ANAlrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />.. SAMPLE s : <
<br />• .; ,.~ #•Ir~a i ~ ..
<br /> MEASUREMENT
<br /> PERMIT --.~•it•~t•-I!•# #;. ay-~. .. r- - st•-ltit#jt•# ';', (~ '.~:' i:':`=
<br />_
<br />:. REQUIREMENT , ~ , c, l , L : ,
<br />, r '.
<br />_
<br />. _
<br />- ~ ~
<br />~
<br />
<br />- _
<br />_
<br />_ _
<br />~C7L ~ Dpi, i ~ l _ ~ . i ' , ~ s -. , -t ~ ., ~ -
<br />I 1
<br /> MEASUREMENT
<br />~I
<br />~SPENDL
<br />-
<br />.
<br />~
<br />:
<br />t.~r~.1~4 t ,.
<br />- PERMIT ;:•-~-~t-~-~•r ;,. ;, ;,,~ .s r.#;r •o-•x•-~t ~5 '70 ~(l':?:- `•:~F
<br />
<br />- - REOUIREMENT ~!~ ;~i~: ~1l)M ;'i
<br />•c- I
<br />-- __ --
<br />~1JL Y U`J r ~ ~ I ~ , ~ . !- SAMPLE ,k •r y '.'_-} '!.., .x '.
<br /> MEASUREMENT
<br />
<br />f
<br />_.
<br />_ PERMIT
<br />fir, .Y. Y:i.;l
<br />?i >; Vic.-1'F ;~>, -
<br />t5 •)i")S'~=}~ F?EPORT Re:P~RT
<br />..
<br />'I~ '
<br />. -
<br />_
<br />- REOUIREMENT ` llRi 'l •.;~'°_~TF
<br />,. .. -
<br />
<br />
<br />'
<br />~
<br />`
<br />'. MEASUREMENT
<br />...
<br />_ _
<br />I
<br />-
<br />-'
<br />- ~ -
<br />1
<br />/
<br />j'
<br />1fry~~~ PERMIT :.
<br />.t.
<br />-
<br />- r;.:q.~;..`
<br />F;t ..y.p.~t.:k._.l..K 1
<br />O '';rF'URT - ~' ~ ty;`;:
<br />{
<br />l f
<br />ti
<br />, . .
<br />, .
<br />
<br />. REQUIREMENT , ;, r.. t`' ••
<br />~ ~.I;
<br />r..
<br />__ _
<br />C C - '~ - _
<br />i i I I- ~,I~IU ~_ "• )::;'.`-;~-
<br /> MEASUREMENT
<br />;s_'~,-. _ PERMIT -.- .r•.. n ;:;z ::~! #it•#;t## 10 . ' GRP
<br /> REQUIREMENT ,~ r_ -,- M HI;•
<br />,1-: n _
<br />r 1 ~ • -
<br />
<br />l'1_ I-' ~'T /~ I'r" i.
<br />_'-P•'tl: )ULr N
<br />SAMPLE
<br />c. ~ .,
<br />_
<br />s ~~ i ( i
<br />_
<br />
<br />x~'~~!
<br />~
<br />'LUENE MEASUREMENT
<br />,
<br />~
<br />~G38;: i 0
<br />PERMIT
<br />~~.{ . -~.,
<br />,1 if#
<br />;r ,.
<br />•It#-~
<br />:. _'PORT
<br />0. 1 _
<br />'!' -
<br />~;~~'
<br /> REQUIREMENT IN~T AX
<br />,
<br />-' N
<br />- .F- 1, 1~ I ~ -
<br />`L.OW, II~i ~,i.If•;I'~" :'pit SAMPLE ~ ~r~:r. 3+••#•-~##a #~tf##
<br />-MEASUREMENT
<br />uRl_) TRF A?iH~~. ~ ~
<br />PERMIT ::I~:.'.F`- =,:-;F ': "- '•ik-;t~,.N #x~~..~t~lf r
<br />REQUIREMENT -
<br />_~
<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 1 "rttlr ° K D<"' ~ry o •. Ih^1 thif doeromem .ne .u fu.chmenh were
<br />/ TELEPHONE
<br />prep^rtd older mr dlrfrlMn or wperHfltwl In ^ceord.nre pith . fTrltm dd~ned
<br />/~ -
<br />/7 /
<br />' DATE
<br />~
<br />~
<br />~V% i
<br />~~
<br />to tnwn tha au^Miled personnel prvprrt! ether •nd ndue/r IM Inlonlrllon
<br />J
<br />//
<br />(///
<br />I
<br />~
<br />/~
<br />1 ~ ' C I
<br />i~
<br />I
<br />J
<br />/
<br />/[
<br />fuhmltlyd. Bred nn m~ InqulrT or the person or penero .hn nrnaRe the I)ftem,
<br />(!
<br />
<br />`
<br />J
<br />(
<br />/
<br />t er Iho~ pennra direcllT re~por~bk for (flherrn~ the Inronrullow, the InfonrglMn ~- " 71l- - ~I
<br />~r I / ~ , , l - ~ G/:: Lr,. - fuMrrllled Is. to the Heft or m7 kno~kdte end haler, Irve. ^rcv nle. ^nd rompkle. ~ ~ ~." ; S
<br />I
<br />F rRINCNAI EXECUTf1/E
<br />NAT
<br />R .
<br />
<br />i ; - • I
<br />' 1 •rn ...re U.l Ihen •re fltnlnunl pen.lne fer suhmlltlnt f.h lnforrulton, t;
<br />O
<br />V
<br />E O
<br />TYPED ~ PRMITED Indudln~ IM poaelutf o! I1ne.ed Irwprtfonrlwnl ror -no.lnE .Id^trorn OFFICER OR AIITHOR12E0 ApENT CODE NUMBER YEAR MO
<br />PLE
<br />pE
<br />
<br />
<br />
<br />SAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /R~f~r~nc~ d/ ittAChm~nta h~r~/
<br />• ~f YS CLAIMED IF "i -`.j'f r:' "'r'.'..- ~`~`~'.
<br />-_ - SFE I A '_, P~~ _
<br />~ ~ .~ _: ~ ~ i r ~iy PAGE L>F
<br />EPA Forttl 3321 IRev 3199) Previous eddloris may be u4ed , I-. ~ l Itl 54a 4-pan POfi11.
<br />
<br />
|