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PERMITTEE NAME/ADDRESS p,,.ra, n.,en r.„,., 1.... „,u, .r ~ •,u.....,,
<br />MAMF. T&A?PPv Nr. ~': -~ 1'"~;:,
<br />ADDRESS T R A Pr F' R ' ! '~ `'
<br />P.o. ~ Tx t'~i
<br />NwTO/!AL POLi,UTMti {~~ SCHMDE FLMINATION SYSTEM (NPDESI '
<br />DISCNpR EINONRORMI6 RWORT IDMRI
<br />/'•761 17-/el FITlt?1R
<br />(SORR aR)
<br />.PERMIT NUMBER DISCNMGE NUMBER s• - PI N.AT.
<br />Form Approved.
<br />OMB No. 2040-0004
<br />Approval expires OS-31-98
<br />!?OFAIf 1
<br />`-O^•:, , n1DSd n{SCflA Rr.n n T' r
<br />MONITORING PERIOD - -
<br />FACILITY
<br />YEAR MO DAV YEAR MO DAV
<br />LOCATION - FROM `~ j TO f)'1 3l a•'•+A y~' DT SCRARCA (J~! anc-
<br />i '~ R : W , E, ~ R i J" P ° 7 P R ~, P R £ $ ~ ;a P q 'MGR ~ ! 6111 l71-?31 !Y4-'161 /j6171 l18-I91 /363/1 NOTE: Reed insWMiarls belors leUno this lorm.
<br />PARAMETER !3 Grd On/PI QUANTITY OR LOADING !4 Grd Onryl QUANTITY OR CONCENTRATION NO. mEOUDICV SAMPLE
<br /> l4G531 !546/1 /3B-451 46-531 15~-611 EX Of TYPE
<br />l31-J71 µALY515
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !ra-eel (54-581 !69701
<br />:~;1 SAMPLE'' ~ Pdad 7ld ad?PRd a#aadd ( i21
<br /> MEASUREMENT '
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<br />SOLIDS. DOTAL SAMPLE ~ RapaOTi .Zglfa7r' atEldpgcd ( 19~
<br />_llSP£MDk;D MEASUREMEISTT
<br />.05,70 1 0 D P RMIT 'ad,MadO sdada ?5 '7th ~ :: 11(,"f.f . .81FP
<br />tPFLUE9T GROSS P6[,+J, REOij{REMEN7 aRa«
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<br />MEASUREMENT ##ddd# acaaas ~ ~l
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<br />(AS rp) MEASUREMENT '
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<br />F'FPLURMT GROS> 7."- f. tl- REQUIREMENT d*1cd4 00 'a
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<br />MEA~iL1REMENT
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<br />ftlttO TkE4T""'~JT PLT "1 '" MEASUREMENT
<br />I~OOSO 1 0 {/ PERMIT REPORT RF?aRT C6+~}~11t atalERRq~:.. ~11:71'~R.+~IIRIE' . 4ae t!'EKt.~^ !I'$Tq+i
<br />F PFLUENT (:R:~iS Y:: L`:E REQUIREMENT 30DA.:AI~ D#ILT FI8 MCD ~ ~~ ~ ~~ ~ ~~ ~ aaaR
<br />OLID$e TCT~L SAMPLE dadada adRadd a¢aRRft ( 14))
<br />!:'i550LYED MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENKTY OF LAW THAT~MAVE PERSONALLY E%AMINEO µD
<br />MIDM WITH THE INFOIUI TON UBMITTFD HEREIN; MD BA$FD O/l TELEPHONE DATE
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<br />i1fP'ifi[~A /~iE>r MY INOl11RY OF iHOBE INgNOU11L5' IMMEDIATELY RESPON4BLE FOq
<br />OBTNNING THE 7NfOM1A710N, 1 IELIEVE THE SUBMy~fjD INFORMATOI IB ~~ - ' ~.r-
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<br />//~A'~ TgUE. ACCURATE MD COMPLETE. 1 AM.AWAiIE THAT'TNERE~ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ~- fl ~}'y~f.~ ~ ay
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<br /> HE Pos9olllTr OF WE MID IMPN$ONMENT..$FE la V.S.C. 1 1001 MD J~ iIONATIMIE OF MINCNAL EXECUTNE
<br /> U.S.C. f 1$1e. IPwlp„YINYI Uwr • nNP iKA//, Mr y ro t 10,000
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<br />TYPED~OR PRINTED rd or nM.+hx,n hprl,u•Inrlt Pre,lw„n
<br />eNndu.rd6Y,va/ OFFlCER OR AUMORI2ED AOEFIT coOE NUMBER YEAR MO DAV
<br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Rel~r~nce en sttschmente hers/
<br />~~ 6 TOTAL IRUR LIF!IT; ~ILf. 9s MAZIF,Oe A>:t1' SETTL6A9T.L SOLI^S LTNTT APPLI''D POR <:gOYa_,2dAR PFRCIP FYF.31p~
<br />F, L' RURDEY 9P S'ADCF RE'?tIIRE!'FRTS ORDER I.A.3. PF.if1iTTRE nasr TARP IILI. R[51~501APLF 17EASCRES TO AP.DCCt Pq
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<br />EPA Form 3320-T 108.95) Previous edition mey be used. n /REP A FORM Td FNC A NO B USED.1 OOrI ~ o ~4, e q 2 j-1 ~ 3 ~ P t
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