|
YEM+w1TIEE NAM E/ADDRESS(/nchrde NATIONAL POLLUTA CHARGE ELIMINATION SYSTEM(NPDES)
<br /> FacilAyN.me/Lowi rent/ 1 DISCHA WITORING REPORT(DMR)
<br /> NAME Y_�r d.It�� �I � �� -�— (2-1 (t7-19J f F1NAL
<br /> ADDRESS L3rjU_....G.ICU_LL1e:�.. _._.. .... ...{.:�.r._._ _ ('r 00C, ( 102 1 A S'TOF11WATF11, SPOIL SPRG E '4TIiF
<br /> PERMIT NUMBER DISCHARGE NUMBER
<br /> FACtILITY MONITORING PERIOD
<br /> ----— ---- ----- — �•-. —.-�— ---� YEAR MO DAY YEAR MO DAY
<br /> LOCATION ___ _ •- FROM V y TO V k, z M Q R 'Iy T�Z 5
<br /> n 'NI', E y E N (7 1� PRES -DENT (20-21) (22-23) (24-25) t' (26-27) (18-29) (30-31) NOTE:Read Instructions before completing this form.
<br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION
<br /> NO. FREQUENCY SAMPLE
<br /> PARAMETER t (Ibs3) ' (54 61) (38 43) (*6 53) (54-61) EX of TYPE
<br /> (32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
<br /> > 162-63 (64-68) (69-70)
<br /> YFi SAMPLE +'� u r:k*-*f**t
<br /> MEASUREMENT{ t/ �.(r 3'
<br /> .w0
<br /> PERMIT en �''; > ti••11k �'i si :. 4 '*C10*0 t ,
<br /> �cuca 1 0 0 b°�� � ;�.a� . , . :t �E�Lz' ,r:Re
<br /> `REQUIREMENT I '. r k :" %•
<br /> F ' N"' r-POSS VAUJI ':• fi' r ttiar.eft 1K f 1a 7; te1 I
<br /> 105, T GTl:L SAMPLE �j
<br /> MEASUREMENT-', .� :'.313. 24.00
<br /> 0;3 J I 0 (} ' PERMrt xa `,"! #t11;s4k"'r :> 47di1Q>h T 1>yi • !:�(1� fi; t+dl iliz 3 : , x.:: ? : wCE/." Mkb
<br /> pEOUIR ENT
<br /> r T• I t T r a 1.0 :? ,M:` .,; .,f,i_,� „ jLy1 tnit
<br /> ..r T
<br /> _,C3L:D3, S F TTL�Ab LE SAMPLE _� �rXtt;tta~„t Lit;rr,:YF ^.•;J=:t�::r:f' 3X;4t rf
<br /> MEASUREMENT + 4
<br /> a t r^ Nw Ld4';ti4ti, c Y4• "�}: `!i4s"�iF y�Y}.#�. ,E -�.rrti �,LyI'�QAeiiSCE/Is RAS014 5 0 4 D PERMIT '"
<br /> Ir t+� • AEQUIpEMENT;W
<br /> f. N1 T Tr
<br /> AIL AND 'PEASE SAMPLE r,:t�r {c7:t r6 'it�%r�x%t 'r:Ar.`•SZ.%k 3 0+ YF�ft# Q4
<br /> t F; .Q N Fr Z r R—is T{i�V MAET, MEASUREMENTiw r Cj l 1 17
<br /> " ,j I
<br /> 4 00556 1 4 • y„ PERmwi cc
<br /> *, �,',�,��.:, #+��#�k � ::>t E;l(L? kAp
<br /> 4EOU1REM8NT „e r -Yi: j t, t " ' �}liwt4
<br /> i,^P C r e+, I c ,•u "r •F,.rI.: :'e�tiif: t• ;1 .;� s, )- • ,
<br /> LRO"t, TO JrL SAMPLE d.
<br /> MEASUREMENT 1.1 7 V. C •.) ( it >
<br /> 1G1+5 i, a 4 {a.PERMtf >o� cv¢ �ot °; �75 1e. x �lC '/rr 'RAB
<br /> RVA 111EQUIREMENT 1 a +, ti 11
<br /> ��4u
<br /> 4 , 114 CONDUIT OR SAMPLE n 1 try ��==¢nG U�rtk{cr'crr Tit�V%'+Yt''- /
<br /> MEASUREMENT,:' ti .U.222 0.552 - 7 i!
<br /> TREA' MEX'T PLA!7 i ,�•
<br /> Gz• PERMIT, x: s• POR Rt R T :,:r,: ;i
<br /> `_•c t,54 1 Q ,4 AEQUIREMENi ` 'a'
<br /> SAMPLE r;s
<br /> i I S S O L Y£i? MEASUREMENT 4• �! ,;
<br /> at
<br /> 7G2'15 Z 0 .. Gs Pr�1MIT ;" REAt7R?. T LY RAB
<br /> �. r, r r REQUIREMENTS 1.tfiu s .a fye '"' t snA ; -
<br /> >r
<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED - TELEPHONE DATE
<br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED
<br /> UV � ON MY INQURY OF THOSE NDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br /> �y OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION
<br /> }.iyrr►tr,� IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG"
<br /> ka n+ >t M r NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING 1 - .50 7��-52
<br /> THE POSSIBILITY OF FINE AND IMPRISONMENT.SEE 18 U.S.C. 1 1001 AND SIGNATURE OF PRINCIPAL ECUTIVE
<br /> 33 U.S.C. 1 1319. (Penalties under than statutes may include fines up to $10,W0
<br /> TYPED OR PRINTED and or maximum imprisonment ofbetwern6 months and 5years.) OFFICER OR AUTHORIZED AGENT ODE NUMBER YEAR MC DAY
<br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS(ReferenreaRattachmenis here)
<br /> OIL XWD GPE!4SE; _+EF, FOOTNOTE F/. - O--T;UST REPORT IF EXEMPTIONS CLAI It D. TSS MUST ;13F REPORTED AT ALL
<br /> TIME34
<br /> EPA Form 3320-1(Rev.949Q Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br />
|