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PERMITTEE NAME/A SS((ncU•de y',;( i(;1.',, NATIONAL POLLUTA HARGE ELIMINATION SYSTEM(NPDES) pproved. <br /> FNaAcr6MryE .',.•- ' DISCHAR -- NITORING REPORT(DMR) o. <br /> �(2. 6 (1�.19)nr FINAL -30-91 <br /> 4?0Ryk1T A. ?iat !Af MAp expi©s 8 <br /> ADDRE!UPhd_BaA2_U <br /> Lo <br /> PERMIT NUMBER ''l is I DISCHARGE NUMBER f <br /> MONITORING PERIOD <br /> FACILITY — —_— _— — �� YEAR MO DAY YEAR MO DAY <br /> LOCATION — _•_ _-' _ :� t' +' FROM _ �1 TO . Hfit1QR ( atitic) }7s'dT$S <br /> NOTE:Read instructions before completing this form. <br /> i 'i= :+ L� t;ri 5 $ �.Irt E'I S O if - [�-_� •� "� '" •' _ (20-11) (22-23)•(2q-23)'•� (26-27) (28-29J (30-31) P 9 <br /> (4 Only) QUANTITY OR LOADING (4CgrdOgly) QUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> / PARAMETER' .y ; N¢S3) (54-61) (38-45)'" (46-53) (54-61J EX OF TYPE <br /> 1• ANALYSIS <br /> MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (62-63) (64-68) (69-70) <br /> SAMPLE <br /> ' MEASUREMENT« ��+. c' 1 <br /> G u G 0 O '• PERMf>~. : ,U '• `' Sw}'' '"1171 f�' fi g• S L C F� <br /> r r, I'lEQUIREMaFNT' _ <br /> ij�+{ t15F E� �•LA}:� 13 <br /> SAMPLE 1�ti 7+4:i�1.'ifit(? ii '�1(:�Lsiilii tiJ'.3�Skrfr tlynY ;1' <br /> rr 1 tEASUREMENT <br /> 1v ')� ) y Q PERMIT `• R";� Y � 3•{ '��13"i `wil i .� :. 7'}."f.�.�111fR ir, t �i �f E � <br /> MfNT ^r, } 714 <br /> 11I. AiiC (yh C+si4 - SAMPLE r Nxn ix .�" X1:i'.7�:y;:. ». L' ti aG Y.'•'..' ,.. �i�.I�:.�'.t ; ' - _ _ <br /> MEASUREMENTr• <br /> l _ �� n{ <br /> 4 S 5 �• ♦3 Q _ «. PERMn:'. "'. '{�'!rl`' �::/ti. '.i.Si >�I : •',r, '�' .r'�`l ti »' ; `�_'#''F"li. ! �fiL <br /> `l 'EOUIRE ENT", k <br /> SAMPLE' yT �i�x1;r>r:;� <br /> MEASUREMENT;. ' t}« I +, `DISICHARGE ;` <br /> Qrq 1a {� i. ~ tC PERMI�}-, L�i � t1�E` % �4� w `,rin �7 Xi� r �1I '.' i _f1. hl�"1 <br /> ej,BEQUTAEMENT '..i ,� d dt k tt' a r 9 i <br /> OLILiSF 7Cib SAMPLE <br /> Ir G U MEASUREMENT: <br /> I4 <br /> 3O ' <br /> e4 <br /> o�ys - : �' PlfRMYt .,; �; i >a�1 w � !: z #tlR1C a <br /> SAMPLE + ?fi tit 4 #Yi; �xr x:�sy i' ><+ �s *i:y; I <br /> MEASUREMENT <br /> r4►4 L 1 0' A t PERMIT ,. ?. ,� :; „ - E D=1 _ r- ?�o d r Xi +p601 t t(C" ! 6 15 U A L <br /> ELIC G j~ MQU1REMENT l 1 x:;it _ t i» � ¢ A :}�� <br /> SAMPLE <br /> MEASUREMENT C <br /> ' _ �. � .•2 PERMIT '�" l..� 1,4�Y�,�•. ;r!.`r ''�' •iN'• �Y j y. � '"'"` .y1" ". `- � I � - N - _ ' <br /> iiEQUIHE►�4ENt� <' ?" '. '' .^,: r '? ..� i <br /> .w t <br /> NAMEMTLE PRINCIPAEEXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED i TELEPHONE DATE <br /> XND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN,AND BASED =� = <br /> ON MY INQUIRY pFOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR , <br /> Brian Pa Dunfee. OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION <br /> MaAarIS TRUE, ACCURATE AND COMPLETE 1 AM AWARE THAT THERE ARE Silo- <br /> '; ;i NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT_SEE 18 U.SC. 1 1001'AND PIG NATURE OFPRINCIPAL CUTIVE 602- 774-5253 91 04 29 <br /> 33 U.S.C. JF 1349.'(Penaltks under them statutes may include fins up,to $10,000 <br /> TYPEDORPRINTED and ormox6rrumiInwdsonmentof between 6 months and 5years.l OFFICER OR AUTHORIZED AGENT ARFA NUMBER YEAR MO DAY <br /> CODF <br /> COMMENTAND EXPLANATION OF ANY VIOLATIONS(Referrnce aU attachments here) <br /> IF MPJ)13CHARGE OCCURS dEPORT'l"1110 Vr5CH4RG6"o OIL ANO GREASE; SEE F90TNQT£ �F/. � ! <br /> EP,i Form 332()•1(Rev.M)Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> 00054/900810-11402 1 <br />