|
PERMITTEE NAME/ADDRESS pnclade Facility Name/Location if Different]
<br />NAME Gt;~~"C~FdE`~ FiJ~~~ "~ 4: ~1L_k~~'dr~tl~I~Tr
<br />ADDRESS I~~~ ~©Fi ~ ~(~~ ~ ~ ~~
<br />P.3Us.. ~. P-1 C ~1
<br />. FACILITY ~~~ ~~~ ~ ~~ ~, P"3 ~ ~~~
<br />LOCATION F~}Ufi:l_A ~~
<br />~t~"T'1`~; ~:. ~..t~i'+#~~ vtts'~~}~r I~IIltl~ Mt~hl~k5
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES)
<br />L.~C DISCHARGE MONITORING REPORT (D R)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />~ ~' ~~'~ MONITORING PERIOD
<br />YEAR MO DAY YE O D Y
<br />8 ? '4c ~ FROM +~ a TO g+ ~'~'
<br />~~R
<br />Form Approved..
<br />OMB No. 2040-0004
<br />~'~ ~ ~0~
<br />~r~i~dt'fi3~~: e F;i~349 i e~i a~ x^~ E i.i~! L.% irt+
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
<br />
<br />EX FReouENCY
<br />OF SAMPLE
<br />
<br />TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />s'. i~~t'~ SAMPLE •?r~•~•?S•#~?1• •###-EF•t~~t• ~•sk•i~~t••~,~•~• 2 )
<br />TDTt`~L_ ~'~C~I~I~RRt13L~ MEASUREMENT
<br />i7Q~St`3 1 C} O PERMIT ~:..: r c~:- ~.:.::-`'- :: .y.~3t•~i• ;.. ., ..'-.rr ,:• _,al-~..~1' ~__ ~~ - , ~ ;r=-,• t
<br />~F'F"LU~i~lT {~Ri`la5 VAL.tJff REQUIREMENT;
<br />:.. •~# tt••tt• . ;.r, t`":-; .4. '_` ,.`.' ~' ~ sip UGFi,.. :~G; fT~
<br />/"til~s~b..~i6~ir 'T'QTo-~lw SAMPLE #•~•3t•#•#'r tf• ##:3•~'•~•~' aY'fit•3: •#'## t ~~}
<br />~ t4,~ ¢3~ } MEASUREMENT
<br />
<br />~
<br />~F~CGtc. 'D ~ (? PERMIT #•#•;##•
<br />a. ;;. s+ ~
<br />'~•.. ~.r.r : ••~#3!•
<br />gs
<br />~;.ci~Sc# }~ ='t:l:'; 2
<br />
<br />h .,... .
<br />- ~/ ~
<br />;' '' -'
<br />l ,.l 4t l l 3 ';c; -,
<br />
<br />~ l ,."ice
<br />w.
<br />E'F'~'h.4J~Nl~'• (~+RCI~~ tii~LU REQUIREMENT;
<br />:.... ~ ~ ###~ ~C'~1~~`. ^;t,°,:~ ~'-'~:;~f<.';' ; ;,, Uia~~ „~,:,,-~•~.-
<br />~ ~~~~.. r ~F~'C~~I~~C ~ I~L..L.Y SAMPLE ~i•~•#••3F•~'3F •~••i#sF•i~••lf3t ####r?t' ~ ,...~ }
<br />~'j ~ S-y~~• j~j~~'~~ MEASUREMENT
<br />G~ rC1,3 I ~ . O PERMIT ......, ..~ :~s ., :t .. ~?.., •a •#•#•~• .g:.. ,. ,.:r•^ ...~,'C3`-` f , .u~:.'~xt,'1 ?~ c.• wl ;~f-.. ;~;
<br />~~~'Lt.3~~IT CvR£?55 VI~~L•.t.3ii REQUIREMENT
<br />... 3~#ir# :,'., ~.. `•:'~"' _' i..~_., 4`di( 1}['t!'l... ? p;,!``'t-
<br />Sli..ti~fd, f ~TE14t7"~F•IIE_!..'Y SAMPLE •#•#xE2i••~•#f 3S•3:•#~F#?f 3:•Yr3~''4•:~•31• { r... l
<br />il? ~ SSpI_i~'E.k3 MEASUREMENT
<br /> PERMIT •..;;,..~. L~. ~ Y ti a~ ;•.. .:.._ •c. • - ty
<br />SFr ~IJ~~T ~i~~1~S 4t~§l..t~~ ~REQUIREMENT< si-#3g# `: ~`~ , .~. ~: .„~~: ;. ! (~ l3{~i~L i~~("?i~i~'+`
<br />~~L~}.~R~~I~r ~~Tr'I''~F'l:?$C.,.L.~!' .SAMPLE #•3F##~E# ###•~•#•~• :~~r-~'3F~.^r c: f
<br />O I ~~aCfL~IL? MEASUREMENT
<br />C313C}~a 1 G° C} PERMIT ., 9u ...... ,. -~~.: ~'• .. t3-~:° •##•~r ~~ r sw-; ~~ ~ . ';'.,-'l.1:. ~ r~ r "r~.•: - _ .:'.,._, t; r r~: _s
<br />.......ti. ...-...~. .•,...P,.-... , ..,. , ,
<br />R:Y P L.II~IV i stiPCW~~ V P'9C..~.7 ,REOUtREMENT
<br />~.- -x- . ~__ -
<br />~_,r- - --- = s~~.~i..a_
<br />.,, .. r-r ~ •-- , v,~ _ ~ s ~.
<br />-~ _ .c~ •_i ;1 ~~ ° t.,:r.-': s.,. - : -:il :-t _
<br />C:It3171`IlUfrlr SAMPLE #•:x•#3rik~4• :t•##4i•-~# ~ 3t ~r _>t~ t
<br />PL1"f"Ei'~17 ~ PtLhL.~!' ~} Z 5SC]1..~1k MEASUREMENT
<br />~~~~3 1 ~ ~ ~ PERMIT .. .. ...r~„'~S ,, 'r~:.. •~#•# >::n~: .~:x~:.2 _q t.. - ,
<br />c~'F'L.LI~{d~" GF~Car"7~ lf~~,,,f„9~ .REQUIREMENT ~ i8#3~ih ~~r,~:~; !t:.,' ~t~.l.~.~' 3~}~ l.~t~Il_ (_~:!~°#~-
<br />'TE'?~QI''II=.J~'€r ~R YVt~§~.~NTr SAMPLE -##•~I••3tit•?3• •3~•ir3F~•7~-# •u•#•IF•Y2•dt.; t ~t3 t
<br />}s [~•~'~~T~f•~rL.I,.Y E3?:,~aSCiLV$ EASUREMENT
<br />tJ1~7.-!• :~ ~1 U PERMIT •:~ c ~r ::, :.:is,.~•. : .r.~••3!r•s:• •;'r-., ;t• .~ ~ .. ~. r .~ ~~•._.
<br />~~~~,v~ra~r ~~~~~~ bJ~I..,~{)~ ~R$OIJ~REMENT ~ •:;•#~~ ~ ~~~.~~.~ ~; - ,,; ~. ~,,; ~~ , ,,,,:~;. u~~~. ~~s~,,E~,~l.
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER - certify ender penalty of law that this acenment and au attachments were
<br />re
<br />ared under m
<br />direction or su
<br />ervision in accordance with a s
<br />stem desi
<br />ned TELEPHON E DATE
<br /> p
<br />p
<br />y
<br />p
<br />y
<br />g
<br />to assure that qualified personnel properly gather and evaluate the information
<br />~....~.~.... ~ submitted. Based on my inquiry of the person or persons who manage the system,
<br />or those persons directly responsible for gathering the information, the information I
<br />1
<br />ny ~- ~C}
<br />' .' U~ `•~ S 1 ~ submitted is, to the best of my knowledge and belief
<br />true
<br />accurate
<br />and complete. ~ ~ 15 s° /°"1g (')t"" i*`C=~
<br />L.
<br />1 ~ ,
<br />,
<br />,
<br />I am axare that there are si
<br />nificant
<br />enalties for submittin
<br />false information SIGNATURE OF PRINCIPAL EXECUTIVE l./ '"', ~/
<br />TYPED OR PRINTED g
<br />p
<br />g
<br />,
<br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
<br />CODE NUMBER YEAR MO DAY .
<br />COMMENT, ANU tAYLA1VA11Urv Vt AIVY VIULAIIUIVJ (Fferef'eI1Ce Hll HI[HCIIIilenrS nereJ
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~3CyC?~~r ~r1`1~S~S~..a7$-~~°~• PAGE tpF
<br />
|