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PERMITTEE NAME/ADDRESS (1M1b FrWry Nw/Ix.nm r)Diefr..u/ <br />NAME THAk'Pf ~' Ki `.I'+'., ,.. <br />ADDRESS T H A P r• r~ k"; :.: <br />Y.U. r'~I'+. .. ~! <br />tHA1~. <br />CJ c)iC ?fi <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTMT fABGHMOE ELIMINATON SYSTEM /NPOfSI. <br />DISCHZ R61EJNQNRORIN6 REPORT lOM91 <br />,:DOU32115 tl~ A <br />PERMIT NUMBER DISCHMOE NUMBFA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ '~ TO - <br />l1011I l72-131 114151 118-17/ l18-191 !3637/ <br />Form Approved. <br />FUNCFF/":YL' rT5 ?Ql~~i~D~'4-~S <br />(S U ° R h 4) Approvelle>Spy((4OS•31-98 <br />F - FihAL <br />f7NCF <br />fi''O !. C. Gi.i l: liARGE (_-~ ,-. . <br />NOTE: Reed imlrueUorr before eompMtinp this form. <br />PARAMETER l3 Grd Onlyl QUANTTY OR LOADING I<6rd Onlyl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> (<653) 154611 f38-<51 /46531 16481 <br />EX OF <br />TYPE <br />/31-371 ANALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-sal 184881 188-701 <br />rn SAMPLE #0 t: '=4: Sri=#4:X? Oi9f,.C+` <br />( 1 a) <br /> MEASUREMENT ~, ~ ~. Q (~ , /Nf~ <br />tiG4U0 1 ~ U ~~.~~P6RMIT:.;~; ~. #4#F,r'.,r'C ~ .~~.>(t.TA4~1.4 4dfi b.S: .. .. ~~O~i~'bAO. Q.~.:~.~.~ ~~ EZKLY IYSIT~ <br />:.Fr'LUENT i,1i055 YALU -~Et1U1REMENT,: : Qx4')p Nj.p.Y7~U! !l.liX319U1S SU <br />~~ <br />,. U5r TUTAI. SAMPLE 4044rG# #rx4044: OCOOAO ( 19) ~ ' <br />-r U :5 F S 1r U is J MEASUREMENT ~ ! /!j , - ~ 0 V (~ <br />v05~U 1 0 0 '. :. d~:d .#. .. 4^4 Is:;i.: <br />: 5';;. 7~' ,NCI;/ >RA6 <br /> <br />:.FFLUENT GROSS VALU <br />;REQU.IREMfyI. <br /> <br />. ., <br />OOdgl . <br />.. <br />a <br /> <br />38Ck:?11Y'G <br /> <br />.`.Dlt •:Y ..~.]C <br /> <br />G/L <br /> <br />'- <br /> <br />.:.NbhT.S! <br />~ , Cl SAMPLE fi`3 •.:•'•`•` "rG#4':': fi000bi t 25) <br /> <br />MEASUREMENT <br />Lp,/ <br />~O./ <br />U / <br />~U~uS 1 .: 0 0 .PERMIT +~- -,•'3=~ =+ xn~.:~ r-t;: xrnoo7a CF1ItNAL FE:ECH1" NCF./ ;P-A E( <br />cFFLUt3HT G~O55 VAL1! REQUIREMENT 40Ce~ _CCP AYG .CkiIY M7C F1L/L f10NT!{ <br />:. J- • + SAMPLE . , ,., :':34'4::::: rCad~ ~ ( I. '~) <br />(AS )rE) MEASUREMENT ~ Sf ~, 'j~ V / <br />O1'.1a5 1 0 O PERMIT '~Le¢44r# 4?^~k#-x ~7r}r 4:.CC000 ?.0 6.0 NCE/ ;;-RAFT <br />1•FF'LUENT GROSS 'lALU REQUIREMENT fi0'.R 30L?: ATG 1kIIY 71X T!G/L MQ1iTN <br />~ ,. ter. SAMPLE ..;: rr {: ;. 44r 4r4;: 4: OL000; 04YOrl4~ ( 19) <br /> MEASUREMENT ~ N~/ N~ ///f N.g <br /> <br />v-1> 1 U <br />PERMIT <br />..~ :.'w. .~ .~glr/01 <br />::~: 404'- 4: 90~L?>'70 0t'0:?0 ~?~ <br />~ <br />.: <br />.'~. .:....~..:,: <br />. <br />~. ~ <br />!1lITI1f <br />:iNAe <br />•. F'FLU ENT Gk05S YALU REQUIREMENT ~ ~ <br />~ ~- .~~ AiglO ~ . . <br />~.: ~t)1:~'}, :~!!.~~~~ NG/L 'GENT <br />Uw s SAMPLE ( 03) r, q0:y :' 0 G i'~fi 0~} 4~bV0 <br />:' }i :111 'L R E A T' ~ F' H T' F L A ti' MEASUREMENT p Q/sue d, Qf f" ~ ~ / /,~>/l <br />;UU~J 1 0 .~. PERMIT. SgP~a R DAT 4fifi0140 Ofi:16'+/: O+Ci~ra# '.;+~ cEt'LY LNSTA. <br />r.FFLUENI' GROSS YRLU REQUIREMENT 3UUA AYG.- DA16Y 1170 f1GD ~=~_~= <br />~ r ~ SAMPLE ^^ ,- 10 Y.~C+7 ( 19) <br />/ <br />DLSSOLVEp MEASUREMENT S'S~O 3-SO Q O li.C <br />/U295 1 0 U PERMIT >', 1.1.1 4u=° a IGMA1 R.'FOR'I ?HLY "~3AD <br />r.FFLUEHT L:HUSS 'lALU .REQUIREMENT. 4a4:fi CR4F-.kVG £ALIX.ES7I Ll;/L <br />NAMErtRLE PRINCIPAL EXECUTrvE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD <br />MILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED OM TELEPHONE DATE <br /> MY INOUIIfY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> <br />F]• Cordoa PeEare OBTNNING THE INFORMATION, 1 BEDEVE THE SUBMITTED INFORMATION 19 <br />TRUE. ACCURATE AND COMPLETE. I AM AWME THAT THERE ME <br />SIGNIRCANT PENILLTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING /J <br />(.+ <br />9]0-824-4401 n <br />98 ' <br />IO <br />23 <br />PrasldenC 6 General Ulana fli <br />S , <br />THE POSSIBILITY OF~FINE MD IMfMYSONMENT. SEE iB U.B.C. E 1001 AND 33 iIONATUIIE OF MIINCMAL EXECUTIVE <br /> <br />TYPED OR PRWTED U.S.C. E IJte. rPMWe4. YI<II eMM ItlRrh. BIrY bcAW nM/ tiro 110.000 <br />warmMhNAn inpriarrwnr W Nnr«n smrneYA rW 6 rrAl <br />OFFICER OR AUTHORIZED AO£NT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe%rencs d/~(nchmsnro hBrel <br />~i5> f, TU'fAL IRO!r LICITS SILL L.E AAIVED, AND iETTLEA5LE S~LIC~ 11"!1? AEFLI~O FCP <=lUYN,2LINP PPECIP ~Y~-9T- <br />~..:: 6URDnN OF P3D(~F F. F.;OIdF.yEyTS U9Dr.R I. A. 3. TD$ MO!:ITOFIFG - I.E.?. 071 E CEEASR - SEY. I. b. 1.(U). <br /><!1 lILY LYcRA(:C TS PTf.4. ST M(1NT Hi-Y AY Y'~lCZ t711ATNC DFD TfID QF Df 7:TF (_ <br />EPA Form 3320-1 109.95) Previous editions maV be used. (REPLACES EPA FORM T40 WHICH MAY NOT eE USED.) 0 017 3 / 9 7 ] 211-164 5 PAGE lOF L <br />