Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include <br />Facility Name/Locali0n i/ di?<renll .i <br />NAMErYR.C'rFR~_-F'1LE;.5-.cnt.nk ADnTA j.-t.~___ <br />ADDRE55~`~ I~Dy1T7(TR ~/1^`__________ <br />---P.R~i3L~LFi29_____________ <br />FACILJTY <br />IACATION _____________ _____ <br />A'P1'Tie R. I-A NCR Rln4 M7 NE ?IAYl GPP <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SY6TEM (NPOFS) <br />DISCHARGE MONITORING REPORT (OMR) <br />IJ-lb) (17-191 <br />- ~ <br />PERMIT NUMBER ouc HAwct nvveaw <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />/10J11 /11Ji) (1d-1S1 II6-171 /1R-191 /]6J11 <br />MINOR <br />(SUBR NC) rTjtl'~P3roved. <br />P - FINAL OMB No. 2000.0004 <br />ACUTE STET T~gr'~~~I~~~~ <br />### NO DISCNASGE #'~~' <br />NOTE: Read instructions before cwriplBUng this form. <br /> (J Card On/y) nUANTITY OR LOADING (4 Card Only) GUALITT OR CONCENTRATION <br />~ ~ - ' <br />~~ <br />~Y <br />PARAMETER (46-53) (5461) (J8-45) (46-53) (5461) NQ? DF SAMPLE <br /> .EX~ ' <br />µgLYgg TYPE <br />(J1-77J - ' <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (x761) (6168j (6970) <br />C5U STATFcE 4dHR ACU SAMPLE <br />MEASUREMENT r„#4#',: ###.:x4 ~~QD~/ <br />'YQ 'CIF###Or ##C### ( 2j). <br />CERIODAPHNIA Q <br />. At7 39 1 0 0 . .PERMIT #r#¢#Q us~ala_ . Y , , Lo.o - - - - -- - a>r#ao#: o~ae##a' ae- ~= ~ <br />`• ~t~~' <br />P L U N 0 V - U REnuusEMENr - _ ~ _ <br />^ ~;, ~.`.~ j. ~ -. <br />C50 STA'1'RE 96HR ACU SAMPLE rx##4#-? ###### ~/ <br />~Q' #401#010 ####IR# <br />23~ <br />( <br />~ <br />PIMEPHALES MEASUREMENT > <br />f/d - .. - . ~ _; <br />~ <br />ANtiC 1 0 D PERMIT ~#0'O:vfL :.###r:0: .. 100 #0:####.~ ,i470##IGla,.l ER-' '• ~. !'; t',' <br />. <br /> <br />'F LU NT :,ROS I REnU1R€l.7ENT; . <br />0 <br />- , -- <br />~ c ~~ ^~ <br />I-.9'--'= <br />' <br /> 'SAMPLE I ~ <br />~ - -~ <br /> MEASUREMENT 9 -- '~ <br />' <br /> 1 <br /> Ir <br />rE <br />n - ~ .:~ ~ *` <br /> j <br />w <br />~ ... { <br /> SAMPLE <br /> <br />M <br />SUR <br />ENT ~ ~ <br />^ <br />~ <br />~ ~ ~ .. <br />_ <br />_ <br />- ^I .. <br />A <br /> EA <br />EM eJ - -~ - ` <br /> `PERMIT ~" <br />' - ~ ~ - ? : ~: <br />I.,.,A, ': ~ ~ <br />~I c~, <br />,': <br />C+' <br />~:y` v: <br />~ <br />~ <br /> RHQUIftEMEM ~' , <br />~ ; <br /> ~ ~ ~ ~ <br />v ~ - .G _ ~ <br /> SAMPLE <br />T~ ' <br /> MEASUREMENT w. Z. <br /> ' <br /> ..PERMIT <br />REQUIREMENT <br />~ <br />~' .. <br />- ~ - ~ ~ <br />.. - ~.a.. <br />l~. ~ - - ;; <br />. ~...~ .~ <br />.fir _Q <br />" .~,.~a~. <br />"'- <br />1~ <br />• <br /> S _ <br />~. ;Z <br />. ?. <br /> <br />r ! <br />i, <br />. <br />c rS' <br /> SAMPLE t' I `~ -- ~ {a <br /> MEASUREMENT <br />-I <br /> PERMIT ~ ~ --'1' .: <br />~ ~ <br />. s ~ ~ (r <br />~~3' <br /> v: <br />RgnU1REMENT. - .. ~ <br />- ~' ~ <br />h-...~ <br />}w+'`. <br />a . <br />y~,liy_. <br />, <br />B <br /> - _ <br />> <br />_ _ IZ, <br /> <br />SAMPLE' <br />- _ <br />_ , <br /> <br />'.. MEASUREMENT. <br /> •' <br />' <br />M .. ~ _~": .~ <br />.' ` ,-' <br />A .-~" °~ , <br />~ <br /> PER <br />IT <br />UIR <br />EMENT- <br />-R4 <br /> <br />~- <br /> <br />~ ' <br /> <br />.:.. <br /> <br />. <br />* <br />( <br /> <br />i ' <br />x <br /> _ <br />~' ~ .~ ~} ~ , <br />. .:F <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 10£RnFV UNDER PENALTY OF LAw THgr I HAVE PERSONALLY EzAMINEO ~ TELEPHONE ' D A T C <br /> AND AM FAMILWR WITH THE INFOgI.IgTpN SUBMITTED HEREIN AND BASED <br /> ON MY INOUIRV OF TFgSE MpVIDUALS IMMEMTELY qE~ NSIBLE FOR , <br /> OBTAWING THE INFORMATION 1 BELIEVE THE Sl1BMITTEO WFORMgTICN IS ~ - <br /> TRUE ACCURATE qND CQMPLET£. I~ AM AWARE THAT THERE ARE <br />IFI <br />PE <br />S FO <br />Sl1BMfTT <br />G FALSE INFORMATIOI INQUd1JG <br />G <br />T <br /> [ANT. <br />N <br />NAL <br />IE <br />R <br />IN <br />SI <br />rHE POSSIBILrtY OF FWE AND IMPRISONMENT. sEE le U5C I tool qN0 <br />d <br />u <br />r <br />r 13 <br />tl <br />i <br />tl <br />h <br />l <br />( <br />P <br />SIGNATURE OF PRINCIPAL EXECUTVE <br />~ <br />~ <br />, _ <br />I <br /> p <br />19. ( <br />ml <br />s <br />ti an <br />er l <br />ne suN(O may mc <br />u <br />t <br />mes <br />o <br />33 USG <br />ZED <br />ENT <br />'~E'a' <br />- <br />~ <br />TYPED OR PRIMED f/0p00'entl nr maumum imprisonment o! beween 6 months and 5 years) OFFICER OR AUTHORI <br />AG NUMBER <br />. <br />, YEAR ' MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rekrence a/I a(uchmenls hert) -' - ~ , <br />~~. <br />ACUTE MET LIMITS BECOME EPPECTZVE 10-1-97. SFE I. ©. 3, PG YZII, FOR DETAxLS OP TEST PROCEDURE. .REPORT, <br />LC50 - STATISTICAL POINT ESTIMATE :INICH IS LETHAL TO SD GF TEST ORGANZ3MS, ANO ATtACR_.ACU!$-tOI-ICTT-7 <br />^~'t91IQS~I ~7-S j2 PAGE 1 <br />