|
.. f,
<br />PERMRTEE.N/a A DRES p ~.eWryNwtsl!Loerrar I/D~pGranr)
<br />F"J,~+y t~~ r:i~ri~
<br />`w(~, f
<br />.+..~
<br />~
<br />NAME .
<br />.
<br />_
<br /> ':af',f'+)~3 f_?F? f~_I ,:, l•~ 24 ?< ~: ~ ;E'. t~ ~ I t l~l:~ f'~!'.= 5
<br />ADDRESS }^] (''y ~/(`~} ~,.,
<br />3-' 1.1 . nJ L7 lb N ..7
<br /> ~Clh"f~~'~~::1 t~:fr:i ~ ~.''~~:~ n
<br />FACILITY ~~Af~f.~~t~'fr G4~c!~t Rt ?`!_.~ti (:f'~1'. i~`,.~G'~~.,t"w"
<br />
<br />
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM_ JNPOESI
<br />DISCHARGE MONITORING REPORT /D RI
<br />PERMIT NUMBER ascNAIIOE NuMeEa
<br />MONITORING PERIOD
<br />YEAA MO• D if YE. MOi DA*Yt
<br />FROM ~ TO
<br />Form Approved. i
<br />OMB No. 2040-0004
<br />~E..ff=~ I^ ~i.tf;'i~7~'~' '~'!:I ;~.1 ~'!r C)1,J3r#f> 7 ~aC,~tr3 ~
<br />NOTE: R~~d 11»trucdtx» b~tor~ compbtiny this Corm.
<br />PARAMETER 4UANTITY OR LOADING 4UALITY OR CONCENTRATION NO, FREOUENCV
<br />OF SAMPLE
<br /> EX TYPE
<br /> ANALYNS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE
<br />.
<br />., MAXIMUM UNITS
<br />ti: :
<br />' SAMPLE -... ., .. .... „ .. ... .
<br />.
<br /> MEASUREMENT _
<br />(.}~1'~ Qt'Z" ~; t"? rJ PERMIT , ,. ... ~,~ ~;w- '.,. ~ . „ a
<br />;
<br />~- ~.
<br />!r l- :'"L_l}~ I %.~S'~i~;~~ ~i~?~.~.,l~
<br />
<br />'~
<br />` RE EN
<br />~EnU.I M Y ~ t`~~;_' ~? , ~ - r,.<, ~~~;
<br />~>> ~I. ~ ' , _}
<br />.3. , ~=, :!
<br />`?
<br />~ -- ,
<br />~
<br />:.... ~,,._ ~
<br />,.; ;
<br />.-.x.. SAMPLE ., W ....., .. ...... ,.., .-. ., . ,.._ ., .. . .
<br />~~;~r~~-£'~O~ ~ MEASUREMENT
<br />~'{
<br />
<br />
<br />E
<br />........
<br />.. _
<br />
<br />.......... <
<br />
<br />
<br />~
<br />
<br />,
<br />,
<br />tY f•~f~.~~:.f~ l ',wYt~.l~im `fit-!L.z.14.
<br />pEQU1REMENT> ~. ~: _. ,.~'~' :
<br />{ !.,k ~
<br />~;~ f,
<br />.._ ._.
<br />;
<br />._.... _.. ~ ..... ~. _ ~< <,~._ SAMPLE '
<br /> MEASUREMENT
<br />) Q
<br />C
<br />~~ a~ r ~i
<br />4 ~ .. ._ k~-ir : , , ~ . , _ ..
<br />.
<br />•
<br />.
<br />1`.~~L~I~~T ~~'tiiti..l~s~ V:~L,.~" 'PERMIT ;
<br /><:REQUIREMENT- fi;_.:~~ _.., _ ~ ,_ `. f~':w...?i-.
<br />"
<br />; i~_ !~,.
<br />. ,,.~~ .r x , . .,. SAMPLE , .. ~.., ,. . „ ...... ., .. ,...., .:;
<br />:
<br />(~~' +' ~ 3 MEASUREMENT
<br /> -PERMIT
<br />`
<br />_
<br />.~.: i" i"±`..t.l~.fr#~' '.'~"i i'°`~G 1 k',rl r
<br />r~.~.t
<br />.
<br />-
<br />REauIREMerrr
<br />..
<br />~:: l ~~ ~. .~,_}..>~'. r.. ~~~:` 7) .. .... fS' 1iC:_/!.. ....,!`. F.
<br />e. .
<br />..
<br />m t~. C ..
<br />' ~ ._ .. :..lr,:-.:..~._ .
<br />SAMPLE ~.:..; : :, , ,
<br /> MEASUREMENT
<br /> PERMIT
<br />~
<br />-
<br />
<br />.
<br />
<br />.G
<br />?~`;"~.~,3~:fr13 Su:~~.:.~t~ ~,~!`51.."rE FiE~UIREtNENT .t~-,.r..~c (~=':.,
<br />`4P=;Y f'~f~_ ~.~,.t~F
<br />._,.r ~. ,., , .~, .. , .. SAMPLE u _ ,......, ,.. ..
<br />_
<br />"~'I-~f~1.1 i"~~~ f 3 F=i`a"i" 4~! s~f~-° MEASUREMENT
<br />~
<br />. -
<br />~
<br />s
<br />~ ~. £ ~
<br />C
<br />}
<br />~
<br />t`~
<br />~ PERMIT'- , ~ . : .... .... .. .:
<br />~#?
<br /># ,
<br />q y
<br />y
<br />»
<br />t
<br />t
<br />T
<br />~
<br />k:.~l-" S.1J~~`~ ~ ~~u~. 'Y W~»~i"3 t~G~f 5»•~ ~y
<br />rF,E~VI~{EMEtYI ...-~~.}`ti~; a~'w :: ,) .. ~_ ~ ~ f~lEi~~ i. ^rt'-2~.'. ~~l} )1'a { i
<br />., . j .. . v-
<br />'
<br />' ....
<br />.. .... , •-.
<br />~
<br />...
<br />._ ., _. „_...
<br />... SAMPLE
<br />t1 ~. ~,,.''~ )~L.. MEASUREMENT
<br />~'
<br />rr;r f~~L.IL:f`1T :~4;~~ `~+ '~~rE..~ l' .:gEi]UIREMEN`f ~ I 4r!E..i~.l~ !, ~: x; ~~; - P~~ t
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t «rtny o er pens ty o aw mat, mla eotvmmt r,nd ou tltachmenu were
<br />stem deal
<br />ned
<br />ervMon In ~
<br />ordsnee witA • s
<br />di
<br />ti
<br />u
<br />d
<br />de TELEPHONE DATE
<br />/
<br />' ^ .1
<br />l /•/1
<br />i {1M ~ `
<br />y
<br />on or a
<br />p
<br />cc
<br />un
<br />r my
<br />rec
<br />prepare
<br />to more the qusNlkd personnel P~~7 isther snd e~eluste the Informrtlion
<br />submitted. Bttaed on mT Inquiry of the person or persom who msns`e the system,
<br />Y
<br />,
<br />(.
<br />, or those penom directly respordbk for plherln` the Inforrrutlon, the InformsUon )
<br />r -
<br />~
<br />r/ /
<br />r submitted la. to the bnl of my knowkd~e snd belief, true, nc~vnte, snd eompkte.
<br />NATl1RE OF PRINCIPAL EXECUTIVE l r ~' ~ ;' ~ - ~ ~ 7 `' r' %• ~ l ~~
<br />/ ii .^
<br />~ /~y / i ,t i em swsre that there sre slptlllnnl pensltlea for mbmltdn~ hbe Informstlon, EIO A A
<br />YypED OR PRINTED InaudinE the poasiblllly of ene snd Imprisonment for knowln` vidsdolsti OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANA~IONiOF ANY ~IO~AT10NS IRS/~t ~~~~~~ cnm ri ~~h~r~,~„~~f.,~t•.i~~ ~~~~~~
<br />! r I r
<br />C
<br />f'
<br />^
<br />1
<br />'
<br />' .~ ~ .. _~. +y ,-, „t n -r ~ fi7 -~
<br />+_~'! i ~'~f~f~'3.._t~ ~=";~f4 ; --.f ~: i'~-., ~.•-.f"ff~~. C ~'ru..l ~ ~-r~
<br />....~~.:>
<br />t
<br />.~
<br />~
<br />_
<br />t~t,
<br />t ~:r ~,<
<br />f
<br />f'1~ I f r:~'t~'~
<br />~{
<br />~a~TTL1E`~I31...~.: o~.fl~L"~ ~~il I... . ~~~':£..~ 1- {..l~ti .x'q.~.} i~~, ctf~lf"f~i .~.~~.Ir~~`"',~"". ~'~
<br />ft
<br />~.i~ 4
<br />ly"-~.f C-s
<br />"
<br />Y't
<br />-~"
<br />m
<br />t
<br />~. ~
<br />.~ :cif ~~ ~ . ~ .
<br />~t
<br />~Sti
<br />.~ ~ f't~
<br />.
<br />.~.. ~ ~f~f~'
<br />3
<br />~
<br />~
<br />.
<br />;
<br />t
<br />i
<br />Q
<br />pp
<br />~~
<br />~~t"1 1'F[Ji~S x l I :t'i # ~1~ „i T•' ~ 5~' /~~ ~ t ~ I t~ ~
<br />~
<br />-y
<br />1 1 ifs 't-'9 ~`t ~ I~l~i f':1 ~ ~i~ ~)s~1'i L~~'~f tY 4 ~ fp
<br />.
<br />~y
<br />(
<br />}
<br />~
<br />f
<br />j
<br />l
<br />¢
<br />z
<br />!"~ 7 t~2"F~~ ~ 1 G~S~f V S-i A... t'~ tH ~ ~~9, ~t~_7 !-t .~ {Z~Z.: ~~ ~'Y~i .~. 4J~ ;y
<br />~g
<br />-
<br />~
<br />S
<br />t
<br />y
<br />-
<br />3'R ,i:.1- e~. 1 J.../.
<br /> +) f ; 4;• g~~ , { , SI7~115~.~11~~a'S4-~16C~brtt7. PAGE tiOF
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used.
<br />
|