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PERMITTEE NA DDRESS(Include NATIONAL POLLU DISCHARGE ELIMINATION SYSTEM(NPDES) Form Approved <br /> Facility Name/Loc, different) DISCHA MONITORING REPORT(DhIR) OMB No.2040-0004 <br /> NAME_j.`^' I�=r:i�''tl 1"�, 1 .LI.�i1 =._--- 17-19 — i +.L. <br /> r Approval expires 9-30-85 <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> .r" <br /> MONITORING PERIOD f, 1't...: r (' <br /> tAcl -- E t <br /> �• YEAR MO DAY YEAR MO DAY <br /> LOCATION --_----------_ FROM ! TO <br /> 01+ :+ �, (20-21 (22.23J (24-25J (26.27) (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> } (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION FREQUENCY PARAMETER ' (46-53) (54-61) '(38-45J (46-53) (54-61) NO. OF SAMPLE <br /> (32.37) _ EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS>< 62.63 (64-68) (69.70) <br /> SAMPLE ,1 ti r• � ,. , , /�R <br /> S MEASUREMENT <br /> PER MIT ,,.;f,ap,%e+'' x a, 3i°•%�'tiw S3 eA <br /> REQUIREMENT <br /> Tt,,,1 A:9- SAMPLE , +,.I..k < . %1�r%, -v•, <br /> .. j ? MEASUREMENT <br /> P a: <br /> I C, - , PERMIT `7�Y ,F;w kp:,y�""r;' ,."."a".W �;ti 8�' rL .}' a �J "w 'S t„w' 'a t» <br /> R QUIRE hN i,,ti a �R, f ;", 3,1•„!,✓,"''" $ ' ,J.� ,,4y. fir;, 6 r �'s%f";', '„ �,','", �, <br /> ..i,.�L `PSN' •'ti3 il.'A SE SAMPLE <br /> X t MEASUREMENT <br /> FERMI i z,> �., r ., {3 ;y + r y, ,� „"< ,y '�, , <br /> G T ✓+>Y}r+d#*fo "$ i',"o 44 9, V'° - 'r ,�f;�`so � r'�� y,�'� ,,a ,(w`4« %:rr-�i ,,, yp�' ��",,, ''}•'�r4 '�i ,',�,;�" ` <br /> a REQUIREMENT 'tay, �w't' � <br /> y- -{°t) /�✓-'t C, c. ,va+ ;a,,�.r /�,,,�w �,3� j ,� <br /> `vS•3 � ^'G AL SAMPLE "'V <br /> MEASUREMENT - <br /> roW <br /> a.L:G C.- PERMIT s :;C , E <br /> f 1 0 3 ,;.' ,i <br /> i EWUIREMEIVT p +v t3 <br /> L IY. t+0IN CJU.I le l.:t`t SAMPLE _ :j.:, r,;.-*I.=•r` •r•�. ^.x 1= r .1P'•, .•.qr <br /> MEASUREMENT <br /> TREAT{ :FNT `rILANi <br /> PERMIT ' $ Y 1i a.. ! sx1�xra ,• « + <br /> - �t REQUIREMENT <br /> 1YIUs.7 <br /> . i1U�7' L - SAMPLE .,.. T -rP%'�C ..:y..4 <br /> / MEASUREMENT <br /> l t.4::+ } '.' PERMJ7' '. �^5a,'T '%"S�t'�t•tit� N '!` W-'A�i •ti•w <br /> REQUIREMENT %,t <br /> , <br /> 6�'k, 1::AS:E SAMPLE f ,- -. C`:'S,r.;y. ,.•� r.�.-,. ,. - r -Y- . <br /> MEASUREMENT <br /> V k.r+L <br /> ,r ti.w Lt V PERMIT 'r': e°°"'t'3 %. a '•- r 'ate a• `$ .. - i ^4L?b'=✓"1`r�T�1,,,Y ,� ,,,�.,xl;a�,:u.3-s} y..a,».:;r,s<`�Fp t°' ,,c ,.�w.l`,/ Ra p , <br /> REQUIREMENT i• I a'' <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM PA MILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED /{ <br /> ON MY INQUIRY OP THOSE INDIVIDVALS IMMEDIATELY RESPONfI■LE POR - .� <br /> 1 ( OBTAIN... THE INFORMATION, I BELIEVE THE SUBMITTED INPORMATION <br /> � Y�I+� ,�K.w y'�•.''..- IS TRUE, ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIG- <br /> Y NIPICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLVDING <br /> ,..ti THE POSSIBILITY OP FINE AND IMPRISONMENT. SEE 19 U.S.C. § 10.1 AND <br /> 33 us.c. § 1319. (Penalties under these statutes may include fines up to$10,000 SIGNATURE OF PRINCIPAL EXECUTIVE <br /> TYPED OR PRINTED andJor maximum Imprisonment of between 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) ' <br /> 7 "Y <br /> 2 a 1. • . Lt'x � = - <br /> I <br /> EPA Form 3320-1 (Rev. 10.79) PREVIOUS EDITION TO BC USED (RCPLACES EPA F-ORM T-40 WHICH MAY NOT DE USED.) PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED. <br />