|
~I PERMITTEE NAME/ADDRESS (]nclude Facility Name/Location ifD~erent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprOVed.
<br />NAME
<br />~ i_~'~; `,: ~; ' "C Ca ';'~:€t;;_ :,.,;";t~t fi.;,.!`;'; s DISCHARGE MONITORING REPORT (DMR) t- OMB No. 2oao-o0oa
<br />t i_,... r~ r Ijar~~~
<br />ADDRESS Ls~~~<::~~i~~ JTCl ~A~.(i~ r' •~ ~ _ ,`~
<br />. x.. - .".j .3~~-~
<br />i ~ Z ~ ,.i : ' PERMIT NUMBER t ~ l,c~~ a'.
<br />DISCHARGE NUMBER ~. _
<br />f~ -#-- "" 'I t
<br />T~~+'4 ~•a..fril..l f f1~Si ._ ... .....
<br />FACiuTY . , _ ' ~ MONITORING PERIOD
<br />.~
<br />~ t " ' ,~ '~ . ',.:. FRO t - _ - .... _
<br />LOCATION~,~~ ~-~~~( -rt + -) ,t G' ~; : , MO DAY YEAR MO DAY -w
<br />EAR X
<br />,- .. _ _ O
<br />Cr t 1°-1: _. :. ? ~ , , ~ ` + , , <. ~' , ~l ~t t-• , j _ ~ .. _ ~., . NOTE R d I t ~ . t .t . b_.f _ I •~' ,. ~ .,.,,,
<br />' ` " ' i ~'~' ~ ~ p ea ns ruc ions a ore comp eting this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE
<br />OF
<br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE
<br />(wt T 1 ,,:tC`) , ~, '. ~ r~~~. r: SAMPLE -'t• r•,s.'~' ;~ ?l ;r [ 7 °' A r - ~ r r
<br />4/' ~ ~11r"'c1_. MEASUREMENT
<br />:3=fir=~,~, ~. PERMIT iF?#iE'~"~'tit• 1~~=.L31~i"t` ~.`~ `. #3E#~~## 3~#?~'#'k #E ~F'3F##•~-fit- ~f'#~st'},i- t ~ ,
<br />1 Fr= Lli~l+1'; t~j.;riw,~ `vji~I...Lf.' REQUIREMENT c,.'r. )`--s r l i1';.~rSl<„'!' ILkl.,l 1
<br />i~5., i t t~~ I,tt1' C ~t-F l.' ,.
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT
<br />.~
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT i
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT '
<br />REQUIREMENT
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT i
<br />REQUIREMENT
<br />NAME/TITLE PRINCIPAL IXECUTIVE FFICER I certify under penalty of taw that this document and all attachments were TELEPHONE DATE
<br />`~ prepared under my direction or supervision in accordance with a system designed ~ I A,/A~
<br />(f Q lr ~' to assure that qualified personnel properly gather and evaluate the mformation [~y,L_I/'!4//~//`///" V
<br />submitted. Based on niy inquiry of [he person or persons who manage the system, ~
<br />~/~~ s'~C ~ or those persons directly responsible for gathering the information, the information
<br />I submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE ~~ ~O ~ 1~~~ ~ O
<br />I am aware that there are significant penalties for submitting false information,
<br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR M DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />} h. ` t 7•
<br />" 1 ~\~ 1€~' ' ~ F~'1i'-r u7i l'. ...-'~3 ... l'j t ;'S I. € .-.. ~~i ~'i 4 j ) ~~t 1 11
<br />tt~~,,~~ t^ _ i ~ k.3 t 1 $ c' t bi ~.~ c.aft~ ~ ~ ~!
<br />~; 1j ('. ! ~~, . i. TC lJi4 q,; ;"S ~. ~ ~ ~.._E tel:?j a -'(..~L 1 ` r., ~ ' ~•`t ~, t ~,~ {..q t. e _ 2 ~ .... ' ,L ~ ~. - -
<br />._ t'}~Y y _.-. -.., _ ...:_ _ . .,. r ~T _ /... . ! ~ {:j t I 1 _ ~ !. ~'._ f ~.,' , t e . . _. x._ Ids ' i. t t_ f..,1 - t_~,€ T..
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Ut } ~ r.iEt r i ):~+,~1;1~15 R.4-~1;E}f©ri11. PAGE ,` OF
<br />--
<br />
|