|
PERMITTEE NAME/ADDRESS (/ndude Facllip~Name/Location fDi$erenrl
<br />NAME CYii!i9 YAMFA YALL1'.Y COP.L COkP.
<br />ADDRESS" i ^F ~~i 1, 1E3 SOLT}ir ~ PCiC >7A{J FR.
<br />tilt;U ;.4:;T MI'sEnAL CLdCLb'
<br />.+:.-LrwOOD Cu tlU1S5
<br />FACiuTv
<br />LOCATION
<br />e.TTN: "OdkI3 '~. KL'GLES~ GEt:h_'P.AL A'1'~Y
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FDrm ApprOVed.
<br />DISCHARGE MONITORING REPORT (OMR~ ~ OMB No. 2040-0004
<br />f2-16/ IP. 9) ,M,~ax Olt
<br />CnlJ7154 OU3 .T (SUER C4) Approval expires 05-37-98
<br />PERMIT NUMBER DISCHARGE NUMBER }' - F I ;r .4 L 3Ji'
<br />MONITORING PERIOD "I~iL 1, FCE~ c: TC FOIL}L CREE'r.
<br />YEAR MO DAY YEAR MO DAY
<br />FROM vv v~ vi TO vv u'.r ~~/ .~ YO CISCHRRGE (~~ '?ri ~`
<br />aazn rzz~z3) rz4~z9) rzss]) rze~z9/ Boat) NOTE: Read Instructions before completing This form.
<br /> (3 Card Onty) QUANTITY OR LOADING (4 Card Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54-67) (,38-45) (4fi~53) (54-61) EX OF TYPE
<br />(3237) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
<br /> rszra) (s4~se) ss-7D)
<br />l n:1 tQ~ ~U': F.L SAMPLE .=.-u: .::t^-u:; :z :.a:: -~-;a ( 19
<br />(A U F F,) MEASUREMENT tt11
<br />N l~ (V A NI) A)R
<br />;J1U45 :; U U
<br />,;-
<br />,;P,ERMIT ~t >ar vyv I .P R C IIC i s G
<br />ik'E CO'tiiE:+TS RF:LU, ,
<br />RE~QU~~EMENT Y ,:- '' ` r>x:? ;j ,~ ~;~0}1A AEG - RALLY ~~i;;, )"U/L ~1(JNTH '
<br />L M. ^I t 'L''~"1'ri L SAMPLE ':aauc. - rt a, r,: r. ;, i..vV
<br />~ 22y~] ~ J
<br />(
<br />n I 1,
<br />13 / r'
<br />~ 2
<br />(n ~ F 3) MEASUREMENT 1 3 .:J l W y UF-
<br />~ v
<br />:'lUIS 1 U U rs ~ ,,:::~; 1 '
<br />EYr'LllC'.1' GkUS_° VALUE AEOUIREMIENT ~"~~+~ ~-,,1. ~- a><~n ~. Y"
<br />. ~ =`3pflA AYsa; ~~[~- Mt'/C ~`~`. jlQli~N ~
<br />
<br />3p
<br />
<br />~. +
<br />
<br />~ . .
<br />.
<br />~ . ;
<br />• wt ,:: UUNUUL lr}r
<br />4T
<br />fl'
<br />:U TRL'e
<br />TP
<br />AT SAMPLE ~-r
<br />~~ 7~
<br />~2" ~
<br />;''
<br />T~ o•art 1: aV G~.:
<br />VJ%t
<br />~
<br />Il
<br />"
<br />'A
<br />..
<br />.
<br />:f:
<br />:
<br />PL MEASUREMENT .
<br />I l
<br />r r Ja
<br />i
<br />~UI)SU 1 U U PERMI P zP,'+ ^'>XO ..: K ~~ ~ 'AH
<br />EF'}'L'JeNT '.',N7.i~ VALUL ,
<br />REOI'IIREM ~
<br />ADx .Aq$~ -DAL ~
<br />` !!GU - ~- #'
<br />$~ '~_; - ~`~ *~~~-~~~ .
<br /> ,
<br />;
<br />.
<br />` . 4:
<br />._ '
<br />~..
<br />JiL NU GeG?~', C
<br />V I v U
<br />L SAMPLE ''~ • `:.• {~ y4 ~ st'v L' - oppG S>: -34:-,:
<br />... Ls
<br />~ '~~~~ ~
<br />m /
<br />~
<br />1
<br />~ fSJ~~
<br />A MEASUREMENT V f ~ I ~
<br />l
<br />.
<br />d~4Uhb 1 U U >~ ~
<br />P,ERMIr. ~~ ax
<br />- ~T .. -
<br />~, £°=1 .y;. ~ ,. 0~m
<br />- .: $U -L
<br />F:FFLUGNT GkOSS YALUE REQUIREMENT- ~i~r'A:![Ax FO=O I '~
<br />%a ~'~~'> '(
<br />) '
<br /> w ._ ~ ,
<br /> SAMPLE ~ }`n ~i
<br /> MEASUREMENT
<br /> +ERMIT r-
<br />~
<br />~R I ME(JT= 5"y~ S.'u .z
<br />~-~~rL~~,.rx
<br />" A4
<br />~ >
<br />r ~,y ia~',
<br />A
<br />
<br />-, .F a ,, .:
<br />40.~s
<br />y;.S~
<br />i.. 2t 'z
<br />.~ ' i - ::
<br />
<br />>; )'
<br />"
<br />it ..
<br />
<br />~~ y~a It' i
<br />~ e
<br />4*'r '~ ' .-
<br />
<br />1.
<br />~-
<br /> ,
<br />. ,Y .
<br />, .
<br />;F
<br />..«
<br />h ~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~•'PERMIT - i ,t
<br />~~ :~~r; ta-2~ T a p+`) "~~.~J~ ~ X.- "S cr~. ~~. §` ~ ~' ,',.,i ~. .
<br /> REOUIREMENTr ~;
<br />~ ' ; _'< T' ! `~ 1 t~ : ~
<br />~ '4`
<br />~ ?I
<br /> - ~ ,,
<br />,{ ;,
<br />}
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~ ~
<br />rM
<br />- I ~ -~
<br /> REQfIIREMEN7 1
<br />f : ,. or .., -
<br /> Y
<br />I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY ENAMINED AND
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
<br />AM FAMILIAR WRH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY ~ TELEPHONE DATE
<br />t
<br />K G erd MI $ INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS TRUE.
<br />Environmental Manager ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES F
<br />R SUBMITT
<br />NCLUDING THE
<br />FALSE
<br />F
<br />RMATIO /Q//~y/)/
<br />~~i~/~ /~/'W :'
<br />
<br />9]O-E7O-2712
<br />ING
<br />IN
<br />N, I
<br />O
<br />O
<br />POSSIBILITY OF FINE AND IMPRISONMENT
<br />SEE to U
<br />S
<br />C § 1001 AND 33 U
<br />S
<br />C /y
<br />~V
<br />~7
<br />.
<br />.
<br />.
<br />.
<br />.
<br />.
<br />(Penerti
<br />4 131 e
<br />ntlar thes
<br />ma
<br />lines
<br />nd
<br />r
<br />t
<br />bl
<br />n
<br />Nd
<br />ro S/a
<br />LVO SIGNATURE OF PRINCIPAL EXECUTIVE L.T J
<br />as u
<br />y ~
<br />r
<br />.
<br />e s
<br />a
<br />es
<br />c
<br />a
<br />up
<br />.
<br />e
<br />o
<br />TYPED OR PRINTED m~ximumimpnsonmemofDeMeen6monNSentlsyaers
<br />l
<br />~• OFFICER OR AUTHORIZED AGENT
<br />~ AEA
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />.
<br />1: ,T,. ODE
<br />";
<br />f
<br />I
<br />1~
<br />COMMENTS AND EXPLANATION OF ANY VIOLAI IONS (Reference ell attachments here) ' "
<br />ALXER6".?'_ LIihI?S FCF TSS, IROti E SETTL1:AflLE: SGLIDS (LO:. 'Ur) APRLY CNLY LF G= 10-Yr, 14-ti5r:-CIP iYENT
<br />CLAtl1i~. S°H 1. A. 2. Pu 2Y, FGi•: uUSfEY OF PROOF kF;UZ!{ayF'NTS. CIL E l-T'Tli~;-_iE£ f''a"1. ,
<br />- i/• ;.
<br />('FTRLY ti1>~DI TNG E Ai P/1GT TNC TNSTpIIf'TTlIy C--MTT Y:"TTC n/. _ ,
<br />EPA Form 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) 0 0 0 3 9 / 0 0 L' 4 0 ~- 1 `~ L 1 PAGE 2 OF
<br />
|