|
PERMITTEE NAME/ADDRESS (GeYJeiaihryNawrvLernon I/DlQirvnr)
<br />NAME a~(`3 v1+;,1 i`~ ~. t~j'~ i ~~ti,i, .):.,.
<br />~~
<br />~?i...;'~
<br />,~i~;'r
<br />`
<br />~
<br />~t E..i`.~~i
<br />i
<br />!
<br />ADDRESS ~ti~•,t i;:i~~. i"i'„t)Y.~.~.i
<br />~~
<br />~~
<br />^-
<br />-
<br />~
<br />•
<br />•
<br />j~
<br />~. («,. .~JU~1 .~J wI MJ
<br />~C33"i:i~i~r3~ 1 iwtl r:s r !; ;~x~
<br />FACILITY ~'~' 'd1t?<.~S cr"J1~ i~ ~ ii`"r'( « )_• 5.,,.1, ~.`• i~ ifa I`a 9. ij-~,~.: W~
<br />LocATN)N Si~P`i:~i~ ~~ ~."~' ~:.I;a I'? ~ rR ^ ~;
<br />t'j l •i )xi: ~ES'-11''~~'.`~ ~ ~«~IJi_d...l4, ?~t+)~~ Scrt. "~.
<br />NATIONAL POLLUTANT aSCHAROE ELIMINATION SYSTEM //NPDESI
<br />DISCHARGE MONITORING REPORT /OMR/
<br />PERMIT NUMBER ascNAROE NuMaEn
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM kl:'S ~ 3 Tp k,.c~ .).t. ,•c.t
<br />Form Approved.
<br />~•»y OMB No. 2040-0004
<br />.~~•3,.1"~~~.a!ii- ~"~i~!~,5~ -f.if3 °1r~}I~.~'dl~f'ej~ %,~.~;lr%
<br />.-::~~•1~• i~~~ i~14t~:~i-`..T,-,rasp 4 ~_f ~•:rF
<br />NOTE: Rsad instructitxa bsfws complstiny this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
<br />
<br />EX FREOUENCV
<br />of SAMPLE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS TYPE
<br />~~~1 SAMPLE •~•~f••~•r: n:~ ,~:•..: ir7~••;~• ?~•:.••tt.~.,H.;.h~. ~ ~ ~,
<br /> MEASUREMENT
<br />(~~,}f-sx~~y ~ ~ P~RMITr :.n ~ :; s. . .:aw; ...r K. s. 3£• ~~' `~, ,_3:1-i s-h '. :.> `.)`),? _ ,
<br />~'i=~:"L4_)~~~~! f ;.~G~~ 'tisL..I~ ItEt1UIR~MENT .-ti'3ak. : , , , , r,;:'~.; ~ s ~,:? ;~; ;_:
<br />'~dL.. ! w r I ~ 4~1... SAMPLE .r; .y`..~.;~ .~..h. -~r •~• :#• ;_ ;5,.~. -•:r ~: #- :: ii• `=3' y
<br />'a~~?!~i:l~ ~~; ~} MEASUREMENT
<br />i-~~'.~"~'~1'~ ~ ~i} 4.i ::p ~ ~C ., •h i:. .; i. r i ~ ,. -s: x.ii n !; ~, ,. ..., .. i~"~`.. r.~. ~r't~'+':~I~
<br />'~•r`' 9°°L~-~I~ i~ ~i'i:3`~::s ti•1~~~l~ •;EQIiIREMENT 7r .. •tk=. - - I-
<br />;ai.:l.. 1 ;x ~L:. ! t ~:.1 SAMPLE :t•*.~roi• ~~: ~~••:~• :'?..:~•,4 ; .... , :~•.: u••:•~••n t /'
<br /> MEASUREMENT
<br />
<br />:z~'F ir..l3~=Rl~~' S~1~t1r3~i~ ,l~:~e t l.#' EtEQU1REMENT ~'Ir••~•a
<br />~` +s
<br />. , .. _
<br />'t~1 ~ ' F', ,.
<br />f'ii.w ~x.
<br />~`s'
<br />x I'~ iti3x t L.i SAMPLE •i~~:t :-..~•tr•'ro •~~•~x•t:.:~.:~ a...:>::. •~••!v-•~: 4 w'~ 3
<br />( ~'~~ ~"~ 7 MEASUREMENT
<br /> `~=PERMIT.. r._~•-, ~v•.. :~'~ r, .f .w x ,.~~ F a.=~, ,~~ •cea;~
<br />Vii' )~~..~~I'~•!• ~'fCl`i,~± '~:~i...~`_~
<br />~. ~REOUIREMENT k: ~~••~, , __ , . _ ...._ . I"~ __
<br />(J ~u % )
<br />3_ f I, ~ ~:3^c~;-•, 7x.: SAMPLE ...... ,..... . , ...: •t~'~• 'k::... ri •~>•k' .. ..c4;•38'; i ..
<br /> MEASUREMENT
<br />t'•}~"~.~~ ~ d1 {'3 'PERMIT ' s; ~ ~-.t.>; ~ r~ ~ •} •t? ~ ~ <. !....
<br />t ~s
<br />:r.,i
<br />•it''l,..t.tYx.~l?#~'~`i•"~/~~i~ 't1~~~;~t+
<br />. :Ei~'EIUIREMENT k~.y.~ _ . ? "'i~":f'6... tx.~,..
<br />I ;d ti
<br />x i~ L,, SAMPLE
<br />.t
<br />r ~.. f. ;i:'-' :::-S<
<br />t..,
<br />7:..:, i=:... ~.
<br />ac ..H .; ..~'.
<br />•,-.•fi~-
<br />'! I~fi-:~1 > i:~~-I"1"i.E:i'~•T ~~~~•: MEASUREMENT
<br />~iC){~~~? ~. ~t ~ PERMIT' ~ _ CSP, ~±3=1-`~! ~ . ~ ~:~~ ?. , .. N_~.. ks. .. ,,..;~.. ., ,: s , _
<br />~::'~•s=L_~/I~I~P3 ~;~t:3a'~.} 'tilt`-':f_~iA RE(1U-REM~N7` ':~~13_~s`; ~~11~-~ ~:}~,1i_Y i";:~, i°'i{;.~J
<br />'K". 'F C
<br />'~ ?' .!.
<br />'
<br />vr. ~ ,~::<::
<br />i_ ~ 1 a SAMPLE ~....... t~ .- +~ '~, ~;• } .. _. , ,... ,. ... ,-i;~ , , ~ ~ ~< .. Y: i~•
<br />tl ~ ~(,lt°~(,,. MEASUREMENT
<br />
<br /> 't'E,RMIT'>~
<br />~F:~ ~"i_f />'~'~ 3 ~l~~~~ Y./1=,~...f..)~ RECIUIREMENT>~ t S d. +. ~~s•<:~~ s~i~'~,L) •;••;:-•3t•*= ~~~:? .
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' «rt~ r n er pem tr o law IhN lhb dowmenund dl.nxhmenb wene
<br />pnp.red under m~ dirxtlon or auperrlalon In .eeord.nn wLLh a aratem desl`ned TELEPHON E DATE
<br />`j r~ !~ •' i .~Z
<br />r- ' ~ - ~
<br />)
<br />r
<br />~ to mun Ih.1 qu.NOed personnel P~~7 6Hher and ev.hrale the Inform.lbn
<br />aubmltled. Ssxd on m~ inquiry or Ike person or persoru who nun.ee the system,
<br />or those penoru directly naporolbk for pthedrK the Information, the Inforrrutlon '
<br />`.y. • ff ~ ' ~
<br />. - ~ ~ ~' '~ J r • ' (~ ~/' ~ } ~" ~ •
<br />
<br />I. ;, r ~ ` l ~
<br />1 ~
<br />'~
<br />~
<br />
<br />~
<br />
<br />i '
<br />
<br />~
<br />. (' , ~, V Y ' ' ~ f '
<br />~ , i~
<br /><• f' ~
<br />submitted k. to the bnt or my knowkd~e and beXef, lreq atcvnle, and mmpkte.
<br />1 am awsn Wu then an alEnlflunt
<br />endtln for whmlitln
<br />hbe Inrornatlon
<br />~
<br />~ EIONATURE OF PRINCIPAL EXECUTIVE
<br />! ! L
<br />`
<br />~ ; I
<br />~ ~
<br />•---
<br />, '' /
<br />t-
<br />TYPED OR PRINTED p
<br />l
<br />,
<br />Indudins the poslbl0ty or ene amt lmprlaonment for knowln~ .IdaUotu. OFFICER OR AUTFIORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRst~r~ncs sll sthchmsnts hers/
<br />":"~~ ~ ~`~~~T•~L. ?I~[)~° ~.ZE~i`t 7 G-~F.)_t.. fib: 'rSr:i:~f~~: F'ai~!?~ ~;)~`z'~'L.~.13! iw ~f'~iw.~~'f:=~ ~..1°~~" ;~:i~~tw~iv~' I;':/~3 ..~~~.t3`tF~, ~~•d°ii~ ',-'i•~# ~:."~~ }:~1.'~f~';
<br />~~. ~ ~`i~.~~,~t..~.. ~:~i..~~'=r i...~~i?: ` r~~~~,tit ~3~ j'~c=~~+~1~~ r~~~ ~ •ii.~Y~: ~~•~~ ~=.~`'~:~~`~ -~~.~: R . ~a. ~., ;~~-~ ~;.-_ ~, ~~ts,~~ z. , r. ~~: r~. ~ i*~~ ~~€~r-~-~
<br /> ~.
<br />1`~')~ €~IC'~.',T ~;"'I~ li#r==:-~~•~ a~:.r, t.~' ,~ ~ t~ t:: ~~r3~u3~3r_;t ~= ~~~ r:~~~• F:~f! }~ ~vr.:~~4~i c~arar~i~;t-~3 ~~ ~tipr~ P"iIII~~•3..an ~~=i~t'~~~< ea~~r--~f-r~~
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~?;,;~'?'! ~+ ~ t}~~IS'~1tStA"a-~~~['~(~rltl PAGE NOF
<br />
|