|
PERIVITTEE NAME/ADDRESS(Include NATIONAL POLLU T DISCHARGE ELIMINATION SYSTEM(NPDES) Form Approved
<br /> me/Loc different), DISCH/ MONITORING REPORT(DMR) OMB No.2040-0004
<br /> t 1 h:g'� 4 1��J'� �,� —-- 17-19 — ( L Approval expires 9-30-85
<br /> PERMIT NUMBER DISCHARGE NUMEHR -
<br />—= ---�----------- MONITORING PERIOD
<br /> FACILITY, { —__--�_----__— YEAR MO DAY YEAR MO DAY
<br /> LOCATION •ter 1 i T—t FROM TO `
<br /> _ • it i r
<br /> 'e' I +, {?;tlFa aR :r• { -• 3';. . I — (20.21) (22-23) (24.25) (26-27J (28-29J (30-31J NOTE: Read instructions before completing this form.
<br /> f k j (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br /> PARAMETER i-. �' (46-53) (54.61) (38-45) (46.53)• (54-61) of
<br /> (32-,7) ••� EX ANALYSIS TYPE
<br /> f .f AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69-70)
<br /> ><'�{ I �• i f ) SAMPLE ,.:i•.I .,t r M y '♦ -f •. ;,?j.;%mat•.°
<br /> T ) 1 MEASUREMENT ,
<br /> tV�(� E 1 %st. p y :a q,$�x��,y�r y� y�y�y�}�+y'� � (i,:r<+�k�i�%�ny} y,-j N,' �f@�% ,., � gyhp 4 �r,��s,��/��/� 'n�,,,. �,'• �y'✓1,/✓r,",•.
<br /> •..�`.'�t V V , M I , ): :�PFw1•M{T 't'rYl°"Y.4"Y•T' T'�Y."'�^i1,,"T'.,; .' "!' j'y.%R d+�9N ' j ,1RN 'ys„ '1W �iH'/,}✓"5 - 'Iy� Y,+�',(',
<br /> a
<br /> -t 3 14A, ✓ rd� "o y
<br /> SAMPLE
<br /> L1� T: TALI� �
<br /> ..fir-va .''��� ,hh• •ti•Y<�r Y
<br /> •, MEASUREMENT �� ' /�• ,
<br /> ,5yi t,C Pi:•�L��i�}t
<br /> ? iJ P6 MIT ,/
<br /> r REQUIREMff{1T y'-' i ':s'Fp �;• H, ••r, y.
<br /> h t l'I♦t`t }1 t t 1 I e✓' x' IM r '��
<br /> �y is. C{� ;, , •i'y.�',/y}
<br />:..'+1,j h��`�,� GiRIi ASL-t�r - y SAMPLE ( ,�I`•ey;kt�Ti`.:u, �,.�•r;t`•. •.r �1 ���*4 its t
<br /> •=k E_0.14 L'KT 1"-'"V{kA I�u.:♦ MEASUREMENT
<br />;.� :.a.-.." •, '�'+.YriRMll' $" { C4". I�°»r,+�. 'S� r `r!r'a + '•� ;'s'" " 'g ,',Y:,• ,3 {:"s'�'n '•a,'g � {%' 4
<br /> 1.,H�'
<br /> y ,+✓r
<br /> �*'i� I•t:.')' r. I'-r ` t r •1 t {{{ F '" ,a ✓', '<AS" ,'A.d r y;�".a
<br /> "` .. -."f 'i F•.t �Y' - U -//'✓ SSG YF�-:`IF''i,
<br /> 1i,3dtIrTNL ' SAMPLE +).
<br /> `•' •S.h� .�_1- �_ MEASUREMENT � � . ..�'-•-
<br /> +� �4•� ' i. 11 - s.PERMIT '' t@�SA ?yll,� „�. >r,,,v ,F - k ^n.;.,,• 'd .y-r' ,,;"/xy' ,+�,'"•�„se yy��y " ,y• ,,,, ,��s yy.uwv�, y, �,�, ,��6y¢.�,i
<br /> � � �•„ b%.4S'� a �, ri�' � 1F }Rt l.:• � ��'r� �p"A��•;
<br /> REQUIREMENT
<br /> 1'S.t, .4 IN CUNf•> -i i SAMPLE V'A 3: 1;.
<br /> rNt MEASUREMENT �\
<br /> PERMIT' y'%��)��p i'lr i «(yN.•�✓x J � ,y 1�•„''r, ,'��, ; �r � ' sayµ�,/•��•�,;,� . �. ���ii '"y',f'� ''3,y'' �(( xxµ4 IyJ,
<br /> i� if: '•I J t + ) REQUIREMENT t } 'y4• ri,e (' h e' "" 9,,,•uri•.,;, /'
<br /> J 4}i IDS♦' TOTAL SAMPLE ih41 �'".R-al•�X'=d� \�` - 1 .
<br /> t L vJLVEO t G/k t MEASUREMENT e p31 1 ✓ •y�� !y
<br /> y J✓ ?9a 1 Fif L{,� 1. I PERMIT $ .ti3 %xl $ ",4 XA R6
<br /> R,EQUIREMENT
<br /> ';r•:=2 1�' ;.�»'�'•;�'; *✓.' �� •1 )'ils,ay ;,;+f''%°'r%�,�„ �/�;,sF•
<br /> ,s•.i•�. A(':L)• t,,rikl�SL SAMPLE i $yi?,..`I•�='� .t}l,,'_ .:1 r, \* ;[
<br /> "I - MEASUREMENT
<br /> qk UAL-
<br /> 41:�3 PERMIT "# ?;' , •?i x o 't �'�`✓ r, " :, cam
<br /> REQUIREMENT
<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY ■XXMINRD TELEPHONE D A T E
<br /> AND AM PA MILIAR WITH THE INFORMATION SUEMITTED HEREIN AND EARED / \\
<br /> 11 , ON MY INQUIRY OF THOSE INDIVIDVALS IMMEDIATELY RESPONSIBLE FOR i
<br /> c 1 �.� OETAININO THE INFORMATION, I ■ELIE VE THE SUEMITTED INFORMATION
<br /> /- IS TRUE, ASCURA TE AND COMILITE. 1 AM AWARE THAT THERE ARE SIO• i �` ( }, , 1 ,��,�,
<br /> > NIFICANT IENALTIE. FO
<br /> OP FINE AND IMIR ISO....T. SR SUE MIT TINE FALSE INFORMATION. INCLUDINE 1
<br /> j�,��, r• �-- THE PORSIEILITY EE IS U.S.C. f -I AND
<br /> t'h �lI}Jlm j J{
<br /> » �•••C• 4 IRIS• (Penalties under these statutes may include finer up to$10,000 SIGNATURE OF PRINCIPAL EXECUTIVE
<br /> TYPED OR PRINTED and)Or maximum imprisonment of between 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT I
<br /> AREA
<br /> CODE NUMBER YEAR MO DAY
<br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br /> iIv IIr rly)1/Jt Hlair�jV w- L L r ,`.1 1(1'1. �• )- tY 3_L`ir 3 a., .. - 1 L. f 1;,.: 1 i r �' •, it I
<br /> .1 f .�."it' AL ...�I.., l�I`.� �J 1 7 f,.l 1 .3.. r - v .,- - ._ . •�.:}• ',i , e � i" � Y - s,. 1 a. '
<br /> EPA Form'8320-1 (ReV!10-79) PREVIOUS EDITION TO BE USED )REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br /> UNTIL SUPPLY IS EXHAUSTED. ,
<br />
|