|
Form Approved.
<br />IMITTEE NAME/ADDRESS (Include Facilit)~.Nante/Locarion:fDfferent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB NO. 2040-0004
<br />~E DISCHARGE MONITORING REPORT (DMR)
<br />)RESS r° •+ ' '4'i .. _.)r<i to .., ~a , 4 -- ,.- ,. - ..
<br />
<br />,.
<br />•-. - ;, PERMIT NUMBER DISCHARGE NUMBER
<br />_
<br />~•- : - ; :: ;, ~.
<br />'..
<br />~..
<br />. ' "' MONITORING PERIOD
<br />' ~. i. ;. I .~i
<br />
<br />'' " `
<br />.
<br />:ILI
<br />TY
<br />
<br />E MO EAR
<br />M Y AR DAY TO Y ... .. O~ D~/.
<br />ATION 'r s _l tz- ` FR
<br />^.. .. . f 't 7 -;
<br />.. .,,. .... ., ,, .. ,. .:.
<br />
<br />
<br />~ ,_
<br />~
<br />i
<br />-
<br />/ ` :-` NOTE. Read Instructions befare completing thl9 forl~.
<br /> ~
<br />N® FREQUENCY' m
<br />SAM' E
<br />E
<br />E~ARA?viETER QUANTITY OR LOADING OUALITY OR CONCENTRATION • OF .
<br />E
<br /> ~ EX TYPE ~
<br /> ANALYSIS
<br /> ~ A1iERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />s
<br />i I SAMPLE ~~.; =: :; .:;: ~ ', sl a = :.i ,..
<br />1
<br />_
<br />.-. REASURE ~
<br />Vim, t
<br />.. ~.. t.
<br />_ ,_... MENT
<br />, PERMIT
<br />
<br />~.
<br />~.
<br />.
<br />.... ...
<br />
<br />
<br />
<br />
<br />,.
<br />.,
<br />., .., .z ..
<br />x
<br />>
<br />
<br />
<br />
<br />
<br />
<br />,
<br />_ _r
<br />., ,-...< ... r-i , s
<br />r ~... ..~
<br />
<br />
<br />_
<br />t 5 t '-
<br />o '. ;
<br />... , . -: _
<br />... r,
<br />s s -__ .... ~ t r -:~ sa
<br />- l REC~UIREMENT 5
<br />., (
<br />•.., f
<br />=
<br />
<br />~
<br />,
<br />_ .. _... i
<br />SAMPLE
<br /><. ~...;.
<br />.......
<br />~ _ •t~ '
<br />=.
<br />.. ~..~.
<br />, ~, .
<br />_
<br />_ ., r?.._ ~ MEASUREMENT ~
<br />
<br />
<br />
<br />`
<br />
<br />~ ` PERMMIT
<br />
<br />
<br />.:~
<br />-:= : >t:, :; ~ L -t ~
<br />
<br />
<br />~
<br />
<br />1 s <
<br />
<br />:..
<br />7. ,J
<br />..; ;~ -
<br />..- ~~
<br />_
<br />
<br />
<br />, ~
<br />.>t.~, R v
<br />~-
<br />
<br />
<br />4~
<br />.^•'r<' :., ~ .. ~
<br />
<br />
<br />
<br />: t~.._.:;• ,
<br />
<br />
<br />
<br />. <. ~~~_~a`~:1.
<br />
<br />
<br />.
<br />
<br />~
<br />_tl~
<br />;i" -~~'f_,r__, Lj ~,._,.~~
<br />F:REQUIREMENT
<br />~.. .:: f I" . i,~.
<br />. <_. .: :.
<br />.. ,..;
<br /> SAMPLE
<br />MEASUREMENT
<br />I ~ `
<br />~
<br />
<br /> PERI•AIT
<br /> REQUIREMENT :~
<br /> I SAMPLE
<br /> MEASUREMENT 1
<br />I PERMIT
<br />i
<br />REQUIREMENT
<br />i
<br /> SAh9PLE
<br /> MEASUREMENT
<br /> PERMIT
<br />I ~
<br /> RE(aU1REMENT j
<br />I SAMPLE ~ ~,
<br />i MEASUREMENT ~
<br /> PERMIT
<br />I REQUIREr47E^JT
<br /> SAMPLE
<br /> t`.REASUREMEPJT i
<br /> PERMR
<br /> REQUIREII~ENT ~
<br />ME/TITLE PRINC°.PAL EXECIDTIVE OFFICER I certify under penalty of law that this document and all attachments were ~ "'-- ~
<br />~' TELEFHOPIE I:PATE
<br />_ _ t
<br />~ ~Y-~`,h.j j~E~ 'r ~~/-~ ~ C.lfv', y . ,~ „ prepared under my direction or supervision in accordance with a system designed
<br />to assure that qualified personnel properly gather and evaluate the information ~
<br />~
<br /> submitted. Based on my inquiry of the person or persons who manage the system, -'""'~`~~- j
<br />~ ~
<br /> or those persons directly responsible for gathering the information, the information -~`~-- ._s^" ~
<br />*~ ~
<br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />1
<br />h
<br />h
<br />i
<br />if SIGNATURE OF PRINCIPAL EXECUTIVE y'7G%m ~Se ~
<br />'_~ ~.~ ' ~ i"~~ `~~ ~'' f % C~
<br />
<br />TYPED ®R PRINTED
<br />am aware t
<br />at t
<br />ere are s
<br />gn
<br />icant penalties for submitting false information,
<br />including the possibilit
<br />of fine and im
<br />risonment for knowin
<br />violations
<br />OFFICER OR AUTHORIZED AGENT
<br />CODE
<br />NUMBER
<br />EAR _
<br />MO
<br />DAY
<br /> y
<br />p
<br />g
<br />.
<br />nimur 1 ~ rawv enr[~mrre wri ~e.'u- rile r v evutil w1V~ (fiClClCl14C d11 aiCdGl1!/IBlliS !IE!@~ }
<br />j
<br />. .. -.
<br />~ ~)
<br />.! i ~ . 1.. _. ... ... ... .. ... ....
<br />Fnrrn 339(1-1 (RP\/ 31991 Pravini is ariitinnc rnau ha ~ rcari PAGE
<br />_..... .._Th.ic_tc a d_nart.fnrm „,OF
<br />
|