|
PERMETTEE NAME/ADDREEE polrAaGyNr+L.,rV« 1/nb...wp
<br />NAME JLfJ~:. :9 ~`!s ~i: ;Z.i. :'t ~. ..... ,iv .i .:. ...
<br />ADDRESS ~) ~~i i~ir. Pv -,)~: ,.._,._
<br />.:;i [~i L&.. v:~` ~s. 134?i
<br />FAaI m
<br />LOCATION
<br />ra'~"!."i3„ .'s £'.~i's' iJ LPa Fi;.c: T'
<br />NArioNDISCHARGE MON TO IR Na REPORT (OMRI~ESI
<br />~... ~. iJ .3 :.:'J ~ It U to
<br />' PERMIT NUMBER dECNMOE NtIMEER
<br />MONITORING PERI00
<br />YEAR MO. DAT Y f^rYEABT-MO. DAY_
<br />FROM *1z a.t to . Tp v_ ...:
<br />Form Approved.
<br />OMB No. 2040-0004
<br />.Elli ak;
<br />(5?5•arx iJ>i~
<br />NOTE: Rud Irwtruetlorr bdors compbtMO thb Corm.
<br />PARAMETER I\ /I QUANTITY OR LOADING I gUALITY OR CONCENTRATION ~ NO. I FREO~uFNCr I SAMPLE
<br />I /~ AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS EX Aquvgg TYPE
<br />SAMPLE
<br />w `r Sr , a } .Y
<br />
<br />:
<br />:
<br />J
<br />'
<br />i ~ PERMIT
<br />
<br />REQUI
<br />MENT ~'s,., ~+~ ~~~#'
<br />r,
<br />~ :~" ~ .. ~,"
<br />
<br />~,t . ..,~ ~ ~ - •r~
<br />
<br />~
<br />~ .~ ~y„
<br />
<br />~
<br />"
<br />~ ®. '~.;
<br />
<br />_~
<br />~? ~~.>
<br />
<br />"
<br />~ ~. ~
<br />
<br />~; .~.
<br />
<br />~
<br />,.:
<br />:.,~,.aA .
<br />,.
<br />...a :
<br />.
<br />...: RE c~a~ ~'y, yf~»,.~r~~k+~a~ <t ,
<br />~~ S
<br />` .
<br />x
<br />a .
<br />.... 'U ' .
<br />•`~, `~`,".;,:^
<br />.. ~.., 1 iv. ~.
<br />~a t......r SAMPLE ....:.:..:........ :;.:'.s.a :,: q; .; :'. %,1.~ :o :~
<br />- _ 3
<br />i~3-`i:~ ;.; :i J', :'v MEASUREMENT
<br />~
<br />u ~ it i I
<br />' ~
<br />- ..
<br />'
<br />` PERMI7 ..x.. ~
<br />
<br />~
<br />~ .%, '+r
<br />
<br />. 9~'
<br />,.. ia' ?~t x~!
<br />
<br />t'"
<br />' n'
<br />'r
<br />~
<br />
<br />~ t k
<br />
<br />(
<br />
<br />°
<br />
<br />`
<br />~~# < '"
<br />
<br />F` °'%~y' '>r .-'
<br />i,
<br />l:
<br />. !.
<br />.e F
<br />i. a :. 3 ..... .x c.',1 <}.. REQUIREMENT .
<br />,
<br />°f '~ ,.,.; •. '
<br />.
<br />a
<br />~
<br />"
<br />~ `
<br />~( ~:~!
<br />~
<br />~ ~ ,.
<br />
<br />
<br /><. 1
<br />v t C B
<br />. :
<br />
<br />.# w _ m+ ax
<br />
<br />~d%f
<br />,r?
<br />fi
<br />i:
<br />
<br />s
<br />" ,~:
<br />;:e F,a, *_s,ror a~... i..,.. ., .., ...._. SAMPLE '- ,,, Y . .s. +,: ~ ..~
<br />IJal a. ,. 3 3 , .
<br />tt )'~C7 ' .e I.
<br />;i
<br />....: 3~~Tt~'sV;%+F) x ~ *&~:i~v. ~4,~„~'.vA@ ...~~ ~r Ala Jai
<br />.. ,a .~.. .. ..... anmrrc - . ... 1 .,. •1
<br />{r",S c:<j MEASUREMENT
<br />
<br />
<br />a ~ f 3 )
<br />a U a .W u ;~ ., " '~ ;l. REQUIREMENT ~ ~'~ ~
<br />i
<br />~ , ,~
<br />,<
<br />'4 i''
<br />~ b
<br />...
<br />`~,
<br />5
<br />
<br />" -~ ,-
<br />
<br />.
<br />
<br />~
<br />
<br />
<br />w,- ~~" ~
<br />
<br />
<br /><, . '
<br />
<br />
<br />.
<br />' r a ''-~ .. ~~.. tt a. _: i; SAMPLE t . a .,.;a :.,...,•., ::.
<br />.,,., -.- .. .
<br />.;..; _, .;
<br />...: iS .,.u., 1',,2i ;` £~I,.~E EASUREMENT
<br />
<br />>JU1~i .'~ 7 U
<br />Ir:1; .+_ I.o...';:~1 ,: it';`,~ PERMIT
<br />;REQUIREMENT ° t e+ - ~',
<br />~ s•,.,;.~~c '
<br />'
<br />:'iC:7 ~ 'rJ('r
<br />•~& :~~, '~~~ "'' .
<br />. ~ iJ. ~.. a
<br />: , e ,. r -,~..~
<br />~~~' 3' a,. 's
<br />iS4sti,
<br />1. ~! ~ .`s L i3 W
<br />NAME/1'fTLEJPJRINCIPAL EXECUTM1
<br />..~~/:c+al (~f.~G:.Yt .~~
<br />M,,,,,'/L V. ~v'r~a
<br />TYPED R PRINTED
<br />PERMIT 1z .~ .:s.`.°~- . }:
<br />_ ,, r -
<br />.vS~=•t7
<br />,REQUIREMENT ~
<br />:i '< ~
<br />M' ~'~,.,..: ~ ~
<br />~,
<br />OFFlCER ~ 1ttl1r" r'P`"e„'ro .. ua ue aoo»rrnm .na ai .nrhasnb»rn ~ ,
<br />„r
<br />-
<br />TE
<br />LEPHONE
<br />DATE
<br />nrtpeM a,aer br ai.rcrbn e. auFe..hion In aeord.an »hn.,n+.•n aeaTnN
<br /> to awn Inb yn.npM F.nonna FnpMT ~pher.m r..laar ur brarnurlon ) as
<br /> roh,aund. Be,eee an my IJbahy of tlb canon or penom »no nbnge ur ry,4m,
<br />or rhos
<br />m alnrr
<br />v
<br />o
<br />hk f
<br />tnM
<br />tl ,.J"_~~'.~.)`~f
<br />+.rQ
<br />-~
<br />'
<br />J"L ' .
<br /> p:ne
<br />y r
<br />y
<br />N
<br />or Le
<br />~ ue Infomb
<br />on, IM Inramrlbn
<br />suhntllrM n. b the htlr or n9 nno+kdp eM betla, rne, emrnle, nM nnipkle.
<br />l em a»ane un uen are 9FdEner Frwuafer,uhnaltlnF ra:lntembtbn ..
<br />.2
<br />~
<br />!
<br />EIONATURE OF PRINpPAL EXECUNVE ~+7.~ ~S ~y yy ~, ~ ~ x ~~.
<br /> ,
<br />I
<br />AWl
<br />10
<br />d l
<br />~
<br /> n
<br />nE Ue lwd4
<br />T Mtlne en
<br />bpabnmrm rer tno»inE adeupu OFFICER OR AUTHORIZED AOEM CODE NUMBER. YEAR MO DAY
<br />4NY VIOLATIONS (Rdirmc~ sll ~fhchmmn h1r~1 - ~ - '
<br />.. e. ~, `f .. ~~~:~ .1~~~~~ .e, x ..Ll~ :'... E..~ ~{.. ~(-. ~ I~~.~r .'. h'~i.'J ~m a....... 1?p.a~
<br />J -.3 x» :. f..4~~ t~C
<br />;lflJ iTT ~i]] 'f' {~~ 1 r9C i~)
<br />L. :~. &JP..~I:°. LJ I're..r ~\ •'~ li y{'A } 7 {~'r ~'gQ r:e~
<br />a1 Yll: e/le J. i~ ~J.J `51
<br /> a-', r(
<br />di
<br />l
<br />L .lv
<br />I ~
<br />±~:aa .Y1i t
<br />Y L"f
<br />~ I
<br />.s:: - :Jm
<br />"`fl 1
<br />U
<br />IfL<
<br />F
<br />: b!~~1'
<br />;d
<br />L. d ~ !l
<br />l
<br />fs
<br />3
<br />v
<br />a
<br />~
<br />~~
<br />`:
<br />E
<br />/ rtC >.~.^
<br />Y
<br />~
<br />L3
<br />,J .:~.. e
<br />a :'
<br />.
<br />+ u. ..
<br />~
<br />,
<br />ti .
<br />r
<br />s
<br />.e...a -J
<br />_ . e..
<br />a.
<br />.+
<br />~
<br />r
<br />. .
<br />a
<br />.
<br />e.
<br />J .. n
<br />i..a
<br />.
<br />s ~.:
<br /> a
<br />EPA Fonn 3320.1(Rev. 3f99)Previoos editions mayhe USed^ ($~+y; l"J~~Th%$~'.S~a'„4^JSA~I ~OFD;I. PAGE qF
<br />
|