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s <br />I <I PERMIT EE NAMElAGGR^~S (Include Faeilrt} Ranl¢/Location if Difjeremi <br />) <br />I~ ~t~l~ NAME - <br />ti. <br />P <br /> <br />~r <br />~II.~~~ <br />N "~. <br />N ' <br />V <br />a <br />o ,~ <br />I <br />Ig <br />0 <br />~i z <br />z <br />d <br />z <br />w <br />z <br />o~'{';{ I <br />t~ <br />N <br />~., <br /> <br />~% <br />,~ <br />~~ <br />dJJ'J <br />i <br />{ <br />Form Approved. itl~: <br />F1.4TIONAL POLLUTANT DISCHARGE ELIf~IIvA'iION SYSTEf~A (1dPDCSJ OMB h.0.2640-~U4 <br />DISCHARGE MOPdITORING REPORT (Df~R/ - <br />'~ ~ ?, <br />:, ;, <br />PC-RMiT NUMBER DISCHARGE NUtui3ER i - ~= ~ - '~ <br />_ m _ . ~. <br />MONITORING PERIOD i <br />rtt4ai I e +- ~ F <br />t YEAR MO„ DAY_ YEAS 0.. DAY <br />=' -.: <br />- <br />,: _ :; i <br />LGCA.7IGN , <br />r I ; ,..'": FROM ~ TD ~~ .. <br />Read Instructions before oompleting this farm. <br />NOTE <br />_ , <br />. <br />r _... , t.±. ... .. <br />, , <br />r <br />. <br />. <br />i FREDUENCY <br />SAMPLE <br />ND <br />. DP <br />QUAN T ITY OR LOADING QUALITY OR CONCENTRATION, <br />PARAMETER <br />I <br />EK ANALYSIS TYPE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />sty 'SAMPLE '."..~ ~ ~~.F ~ ..,. <br /> MEASUREMENT <br /> <br />~ _ <br />,.d <br /> <br />PEAhTIT <br />~' <br /> <br />~~ <br />, ~ <br /> <br />I _ <br />.:: 5 , ,C <br />ter; P <br />'~;~~ <br />F , <br />kl <br />~ EtEO~JIttEMENT I?h;= ~ _ ~ i <br />. <br />. <br />. <br />_. <br />car <br />7 ;-, °; <br />, ~ ti <br />__ . , <br />. _,.. <br />^i iu}a s <br /> <br /> <br />A ,LE <br /> <br />MP <br /> <br />T <br />I EA UREMEN ~F M1 ± . - <br /> <br /> <br /> <br /> <br /> <br />~ , ,, r ,. ,.. - <br /> <br /> <br /> <br />, <br /> <br /> <br />' e <br />O ---- <br /> <br /> <br /> <br /> <br /> <br /> <br />~af , ;:~ <br />r <br />., PERMIT <br />: , <br />I . <br /> <br />. <br />e <br />r - I <br />...wry,) , ~, ~g <br />, ~ REQUIF3EMENT i , ..~ <br />„_ . ~ ,, , , . , <br />;,, : i._ I <br /> <br /> <br />.,.-.t~ _,,.~ ~~. _...~ <br /> <br />SAMPLE <br /> <br />~« <br />i <br /> <br />~~r;..~n <br /> <br />d <br /> <br />_.?. _ <br /> MEASUREMENT <br /> <br />. <br /> <br />_f.. ~~.~ - -• <br />PERMIT <br />~,,.: <br />~,, <br />:M~: _ <br />~-_--- <br /> <br />I <br />`_ <br /> <br />~. <br />_"~"i rarF.'~ , ~r`..),..1..i r.._. .M~ <br />. <br /> <br /> <br />tat '.~... i ~1.., REQUIRIwMENT <br /> <br /> <br /> <br />AMPLE <br /> <br /> <br /> <br /><-~ ~. I I c'` <br />... <br />.. <br /> <br />+:. <br /> <br />~. <br />,. I <br />- k ., <br />r z.r;.. <br /> <br /> <br />.. <br />T"~ } MEASUREMENT <br />} mi <br />rtit.4~'~, ,",'~~ i'i~._.i•.la. PERMIT <br />REOUJR~MENT <br /> <br />., _,.. <br />- <br />~ <br /> <br />~_ <br />,,-. . , i <br />~ , <br />r <br />I'ti,~~. <br />~~~~ <br />J ~, <br />,: _, ... <br />_~ <br /> <br />i, ,. ~ _ _, ~ - <br /> <br /> <br /> <br />AMPLE <br /> <br /> <br /> <br />.: <br /> <br /> <br />~ <br />Y I MEASUREMENT <br /> <br />t ., u <br /> <br />.. <br />~ T <br /> <br />~ tR V, <br /> <br />•_: <br /> <br />r~ ~.: .n_~. _ <br /> <br /> <br />: <br />P <br /> I'.r <br />(~'~ ~.. ,4'~ `;~~=:~t``~- SAMPLE .h.~ ~ ; ~.~. _ . ~ ~ , ", . <br /> MEASUREMENT <br /> <br />}.--1L P r,~C <br />rF I.1' <br />':-. i ..- <br />i <br />i <br /> <br />_~ <br /> <br />.... <br /> <br />. . <br /> <br /> <br /> <br />. <br />e... <br /> <br />Il <br /> <br />~~. t` s..!a...st ~ ,.'t~C`;..~ ,r. ,__ lw, J <br />REQUTAENT F. <br />~ „:.:. <br />~;, .. <br />~ _ ' <br /> <br />,,._ ,,,,i , , <br />SAMPLE <br /> <br />-- ~- <br />~""`~t c-' :,=. tie r. )- ~'~ "~`` MEASUREMENT <br />~~ _ ~ PENT i <br /> ~ I <br />sr re <br />t c ants e <br />~~ [certif und <br />n d went and ell eta hm <br />NAME(1'ITLE PRINCIPAL EXECUTIVE OFFICER y erpe attyonawmattNs ocu <br /> <br />PHONE <br />TELE DATE <br />prepared under my direclioo or supervision in accord~aoce with a rystem designed <br />/ ~ 1I <br />~~ ~~ to assure fhatqualified personnel properly gather and evahia[e the information <br />' <br />~ <br />r/~+ <br />t` <br />OM <br />t suhmitled.Based on my inquiry of the person or personswho manage the system, <br />or those persons directly responsible Par gathering the information, fhe information <br />J <br />J : ~ D C a?! ors submitted is, to the best of m huawled a and belief, true. accurate, and com late. <br />~ <br />(GN UREGFPRINCIPALEXECUiIVE ~Q ~ ~ , t7 O ~ ~ Y Q <br />[amawarzthattherearesiguilicantpenaltiesFors<F6mittingfa)seinformatlon, <br />" 0 FICERGRAUTHORIZEDAGENT NUMBER YEAR Ml~ 4~AY <br />meandimprisonmentforknowingviolafions. _ <br />7YPEDORPRINTED includingthepossibilitycff CGDE <br />~~ }t~ <br />•.a = <br />., <br />-'~~ i <br />~~ ~~ <br />F_ <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference alt at+achmenfs here) U <br />I ,., <br />_~ <br />,.. .. _, ,. ~ r. <br />.. Try, Pt <br />------ , <br />