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PERMITTEE.E/ADDRESS Include •� <br /> Facility Name/Location ifdifferent; ( NATIONAL POLL.T DISCHARGE ELIMINATION SYSTEM/NPDESI <br /> DISCHARGE MONITORING REPORT/DMR) <br /> -�O TZI �E541R� .�I Ca-- 2-16 17.19 F - FINAL <br /> L—co 9136 01 A TOTAL DISCHARGE FACILITY <br /> IPERMIT NUMBER olscHwwcE NUM eER <br /> FACILITY MONITORING PERIOD <br /> --- ------ YEAR MO DAY YEAR MO DAY <br /> LOCATION FROM TO L MINOR PITRN <br /> A TT N: DOUG L A S W BOWMAN (20-21) 122-23) (24-25) (26.27) (28.291 (30.31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (3845) (46-53) FREQUENCY <br /> (54�1) NO. SAMPLE <br /> OF <br /> (32-37) EX gNAL <br /> 6EX <br /> TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> .y .w..Ar (64-68) (69-70) <br /> PH A ✓.A A A YYYYYI 4✓.JI Y-I. <br /> SAMPLE rY rY YY <br /> MEASUREMENT ft <br /> .A, <br /> 00400 1 0 0 PERMIT "� `rr✓+t'+F: �YT��f' `. Y## C3. 5 Y '#✓+�## 9.J iEEKL GRAB <br /> EFFLUENT GROSS vALvEQUTAEMENr `" Y FY At <br /> "✓ M NI MAXIMUM Su <br /> SOLIDS, TOTAL SAMPLE Ar �" A+ k`r rytvy SY <br /> SUSPENDED MEASUREMENT !� <br /> 00530 1 0 O PERMITS##AkY2= REPORT REPORT: O�1CB/;; GRAB <br /> EFFLUENT GROSS YALO EQuIAEMSNTY AA <br /> A*r . 30DA AVG DAILY NJ MG/L <br /> SOLIDS, SETTLEABLE <br /> SAMPLE y rYYY MMYYY Yy yy <br /> MEASUREMENT <br /> 00545 1 0 O PERMIT . OPTIONAL <br /> EQUTAEM£NT REPORT ONCE/: GRAB <br /> EFFLUENT (GROSS VALU - ### <br /> OIL AND GREASE SAMPLE <br /> FREON EBTR—GRAY <br /> � XET frEASUREMENT <br /> OOSSb 1 0 0 PERMIT OPTIONAL l0 <br /> EFFLUENT GROSS YflLU ?REQUIREMENT, Y### fi;E$ I.: GRA$. <br /> IROAi, TOTAL SAMPLE Y YY�` v YY `# <br /> (AS FG� MEASUREMENT <br /> O10�t5 1 0 O PER41IT EASUREMENT REPORT REPORT ONCE/" GRAB`' <br /> EFFL ENT GROSS VALI ### <br /> FLOE, IN CONDUIT OR SAMPLE <br /> THRC1 TREATMENT PLAN EASUREMENT <br /> 50050 1 0 0 PERMIT DEPORT REPORT r # #Y ## ### ###y <br /> EFFLUENT GROSS VALUER EQu1R£MeNT r-D fiBEKL IIASTA <br /> SOLIDS, TOTAL SAMPLE <br /> DISSOLVED `MGl IR <br /> /��77 ) MEASUREMENT ww. �qI b <br /> 70295 1 O L PERIT #+�v�;r REPORT Q�ryY' GRAB..- <br /> FL S V LU R£QUIREMENT <br /> �f v <br /> LM <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY CINDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> �r-� AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED ` <br /> ��� ry/ �'1� ON My INOUIRv OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> 4�7 <br /> //�Y�'V v OBTAINING THE INFORMATION 1 BELIEVE THE SUBMITTED INFORMATION '1 <br /> IS R!F ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> THNIF IC A'V7 VENAL If 1 E SO IMPRMITTISONMENT <br /> FALSE INFORMATION.ORMASC INCLUDING 7NA <br /> /THEPO 11319' OF FINE ANLr IMPRISONMENT SEE IB U;n 4 1t,, AND 3 USt-.S i3L9 !. 1(rr. umlrr-thr•,.r emrut,•. error ulr(mir/rnv.r up 3lu(lxr `✓IGNATURE OF P ECUTIVETYPED OR PRINTED �Inf 1 I Pn. mnn•nr of h.to ern 6nrnnth.and i�rar.vr OFFICER OR AU AGENT AREA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS IRelerrnrr all atnlr hnu•ntl here) <br /> IF NO DISCHARGE OCCURS REPORT NO DISCHARGE ONJOUR DMR. OIL E GREASE NOW 2 PARAM* NO SHEEN: 84066=0 <br /> �. 556=0, A SHEEN: 84066=1, 556=GRAB, SALINITY MEAS. AS TDS. TSS,SETT.SOL, E IRON DO LIMIT PREPRINTED ON <br /> GrM CrTn Q �R Y. tY/ 1 W NT S NFPLACES EPA FORM T-40 WHICH MAY NOT BE VSED.)UNTIL SUPPLY IS EXHAUSTED. O �' 1 1�,I��' 71 ����',�—'�I ;I CI PAGE 11OP <br />