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PERMITTEE NAME/! SS/Include NATIONAL POLLUTAI` CHARGE ELIMINATION SYSTEM(NPDES)
<br /> Facility Name/Local rent/ ' ,,, 1 DISC A NITORING REPORT(DMR)
<br /> NAME_ t. �CD� t C 1-' 2,1 (17-19 Ik !_ + i' ► { I,
<br /> X.
<br /> ADDRESS 3C S i.IL���.F._ -- -r —�•—.___L 'C'(-�QC}liVj 3 r ;;'� ► �(i`!°Lt/•,'T £R, aL SPN i
<br /> 'i PERMITN MBER DISCHARGE NUMBER j:
<br /> -- -- �— �----- (' i MONITORING PERfOD it
<br /> FACILITY
<br /> 'YEAR M DAY YEAR MO pAY I ;i
<br /> LOCATION___ _ _ .._ FROM TO 0
<br /> ft a +. ?�"T OF ' 1 - v11TR3
<br /> " T►: : n F'1!i S- `V F`3 S O N PRIES T N I (20.21) (22-23) (24-25) (26 27) (28-29) (30 31J NOTE:Read Instructions before completing this form.
<br /> (3 Card Only) QUANTITY OR LOADING (4CardOnly) QUALITY OR CONCENTRATION FREQUENCY
<br /> PARAMETER "� (46-53) (54-61) i (3845) i(46-53) (54-6// NO. SAMPLE
<br /> EX OF TYPE
<br /> (32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM. UNITS ANALYSIS
<br /> (62-63) (64-68) (69-70)
<br /> I"tI SAMPLEr=:c�Ft4r;t
<br /> - MEASUREMENT-
<br /> 04 l } 0 } " PERMIT :5:.}bY##ifrl% !!.ttScLll�I L�IZ=X� '.::;t:;: (�# r ox�i�;t QtAa�;s1l Q 'i E EI:L T I R A
<br /> r^C T ° L'►.' t: f)rio tr 1 REQUIREMENTro ' '� ',. 1r .. :t t;.• *Y' i S
<br /> 0 L I D S 10TAL SAMPLE
<br /> U S P F.ti L D MEASUREMENT • 6 7 /p. V✓14 J
<br /> ` �i. C3
<br /> US1V j 0 0 PERMIT /. a:w r�#" �I,t.a 70C'- trA -c'sit fty'J,17i."-r.�' - 5 i
<br /> I ('1 R071 q 1' REQUIREMENT ! �" Q _ „t ;;'i! • t c f flr } t rrFi t�.A
<br /> • r r
<br /> �-OLI LS, `s4'1'i'L+rALPLt SAMPLE :A1; �' 11i'Z XI4;}'f,:fpof ft*,* ^
<br /> MEASUREMENT II �t t✓ I !130 4kK dl?
<br /> iC,514 S 0 0 0 PERMIT'.'- y� /�{y 'yt t i >;• ♦ tSrl
<br /> t t" x� I. / tl V�Z.i ':` is D�.'a.� '71 of
<br /> REQUIREMENT V t, { 1( fr, j II ' ♦,i
<br /> 1 ( r r ! t
<br /> .AIL AND GREASE SAMPLE �it:=y..�s. :•r:�Ii1: #� %r+: :c:. ti :x�:vftf:tr
<br /> ""EON EXTV—GRAV •T MEASUREMENT 1 I •�
<br /> M�
<br /> .i 0 .h 1 0 0 PERMIT µ 7�1y1#i` ?r [7�t '!4 t:;: z�t;�X?i4�`i# #aocts#` I Ors,ew 'i; MK.
<br /> T t 1• 'REQUIREMENT ' •3 '� ! •i, E A E
<br /> r, A 11 ;t fr i i:..1: i' M Y 7
<br /> i 0 N, TOTAL SAMPLE
<br /> (n MEASUREMENT 10 1 31
<br /> ul Ct+�/ 1 fl +� PERMIT a ;X�$I�if;itX i c1;.:;t # Af 1, -v .'
<br /> 7.d �1C f/ FA 8
<br /> REQUIREMENT ri•V
<br /> j'C• r•r't'? f C " !1 t F t 6 ^ :"+,I :tom .r, •. - nuy, ,ld M�' 1
<br /> xLO-o , IN CONDUIT OR SAMPLE �.•�) z: �>:Y:z;: t`�titi�txt Y:;:'>::;:`>tkt,
<br /> T HRIJ TREATF!E;1T FLAN1 MEASUREMENT Or77S, Q, 76� T�
<br /> _xri0 }�l 1 a 3 REQU(REM T iJR ,.. �'{EpORwe 7fe."-°��t�ttx t�>a'.���Lt„ '. 'i���1"r�tlr;si .1 r �r
<br /> G ♦ I^ T rTr 1 r m �. f t 2 �• w t.4�c F
<br /> S� Li N1rJ14�
<br /> t'!� .A. a �. . .t ✓ �,i% '. A•'.--
<br /> JLIDS, TOTAL SAMPLE iM1,�s;l.,Lltt. f,Ys;cet ,,:{t .,,t. :' Zt;;t:tft
<br /> MEASUREMENT'
<br /> DISSOLL'ED ��, 5 • rT
<br /> 702r35, 0 0 PERMIT A***4## ' („t��t%I%C rs�r 1:t Kttpl Ctt} , +�:~o' iJ • REP09T TRLY RAP
<br /> µREQU1REMEN ,Z. 4�, ,M W, e.
<br /> 't 1
<br /> NAMEIfITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED TELEPHONE DATE
<br /> AND AMY FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED
<br /> ON i
<br /> M INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br /> �f ,an T Jlee. OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION
<br /> IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG- O
<br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br /> THE POSSIBILITY OF FINE AND IMPRISONMENT.SEE 18 U.S.C. 1 1001 AND SIGNATUREOFPRINCI PLEXECUTIVE ; J -� ?
<br /> 33 U.S.C. 1 1319. (Penalties under thew statutes may include fines up to $10,0i00
<br /> TYPED OR PRINTED and or maximum imprisonment ojbetween6 months OndSyears.) OFFICER OR AUTHORIZED AGENT j AEA (NUMBER YEAR MO DAY
<br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS(Referenceal/agachments here);,
<br /> OIL AVE) G:RERSE; SSE FnOTHOTE F/. � O�—t1iJST i:c.sa'?ft2 IF EXF"tY?IO'�S CLAZyiED. ISS MDS:� F3F Rt! 0rt'TF4) AT ALL
<br /> TI ill FS
<br /> EPA Form 3320-1(Rev.9-M)Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br /> Q0031/1C05:?1 17411 ' �
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