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PERMITTEE NAME/ADDRESS rlnrludr Fiirili[v.Vn,nr~Larvtlio» ij17i,Berenr/ <br />NAME .t'.i:. `~ . <br />i ~i ~-~ <br />ADDRESS - • - - ~ ~ ~ )- <br />(' n F3164 <br />FAC WTY ;)-- <br />LOCATION; - ~ O H Z 64 <br />nor. M*TrC wtnnsnr-L;Fr <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM {NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />M I MOR OMB No. 20aa-oooa <br />tSU[?f; ~:.. <br />~ - F I r3H!_ ~BLt~+n <br />55- Z SL.l7T STQRAGE Tp ft 1"U WASH <br />I ~t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREQUENCY <br />OF SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> _ _ . f•'~ <br />~- PERMIT <br />- ~ REQUIREMENT `' ' ' ' <br />- SAMPLE <br />.iF f{ ~ , ,_ MEASUREMENT <br />. = I: PERMIT •-- ~ ~ : _ ~ , ._ i~ . ,. ~ , .- ,~, ._ <br />':FF'L'~;i~N i :' ..-. REQUIREMENT ' <br />r E ~? `~ ~ L .I ~i~'~ : SAMPLE <br />+. E ~OV?sR4~ L. E - MEASUREMENT <br /> - 'r ~ .•~~,-- - <br />...'~c t r PERMIT ~ ' :. <br />(= F REQUIREMENT - <br />'" ~ SAMPLE <br />7 L ~~ . - MEASUREMENT <br /> PERMIT Y. ,-x=_ .:?, ,^r: <br />__F '. :_ ~ - REQUIREMENT <br />_ <br />SAMPLE ,, <br />r=~~r t - _ ~: ~ _ MEASUREMENT <br /> .: ~ <br /> <br />~_ <br />PERMIT - <br />- it <br />~ <br />. ~ :i ~ r' i~. I <br />r ,. , <br />~ ~ ... <br />•= r ' i ... ". ' REQUIREMENT . -`:?r: ~lf-I l 1. <br />G ~ - SAMPLE <br />- ~" <br />Q-(ftil MEASUREMENT <br />_ <br />i PERMIT 1~ n .. ,: ,- , ,~ ~ _ r' ._ .. ... , • r <br />,:: F : ~ ~ ~ REQUIREMENT 30L~rr; h• ~ '_ ,. i°` . <br /> SAMPLE <br />T(. MEASUREMENT <br /> PERMIT - .. - s .. # i - .- -.. _ < ~ .-., ' t:, . ~ , ~ ~ .. <br /> REQUIREMENT .~ ~: i~; r r'-` " .a <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ Certify under penalty or law t}Ial IhL d(KUment and all altaLhmn]ht KC1B <br />arcd under my directiuo or sup(rvision in accordance with a system dcsibmed <br />+rc TELEPHONE DATE <br />J l ~~ ~ r'~ _ I <br />p <br />t„ 1.>urc thnl quulilicri Ixrsonnel properh~ gather and ~w~aluntt the infurnutiun ~ f+~'~ -_- "-• -r' <br />`= ` <br />- submitted. Based on my inquiry of the person or Iw-r~orts wFu+ vutnnge the rystcm, ~/ v <br />. <br />~ <br />~ <br /> the mformmron <br />onsible (or gathering the rofotmntion <br />res <br />enoru directl <br />r th ~ ~' <br />"~ <br />' <br /> . <br />ose p <br />y <br />p <br />o <br />l <br />t <br />d <br />' <br />` _ ``// <br />~'~) t ~ comp <br />e <br />e. <br />submitted ts, to the best of my knowledge and belief, true .xtvrate. +m SIGNATURE OF PRINCIPAL EXECUTIVE _ - <br />- - - ~ ~ T <br /> 1 am aware that there an: srgnificant penalties for subnu« me faLu inlorination, O <br />CER OR AUTHORIZED AGENT AREA <br /> l <br />ti <br />i <br />f <br />m <br />i <br />~i <br />i <br />d FFI CODE NUMBER YEAR MO DAY <br />TYPE6 OR PRINTED ow <br />a <br />impr <br />sonment <br />or <br />ng <br />u <br />ons <br />including the posstbdify of <br />mc an <br />GUMMtN 1 J Arvu CArLNtvAt tvn yr ..r.. .wu+~ r.~~w t• ~, ~. ~....~ .,......« ................... ... <br />EPA Form 3320-t (Rev. 3/99) Previous t3ditlons may be used. <br />ills 1S 3 '}-h$ft tUl~f ll. FAGE Or <br />