|
NAME/ADDRE$S (Inch.de Faciliry Name2ocarion i/DigerenQ
<br />NAME
<br />CYP~Ui Y1'!PA Y1L1.'?Y =:IAL "'14P,
<br />ADDRESSw IN° ~ 1, 7" 4 '+'1 r!T".e ~ c^TrA?) PyQ
<br />vIIJD P7~T aIti°A •i. "I.~:L-: L1J
<br />FACILfTY 'V`'L.'a J7~ ""t 97I~~
<br />LOCATION ll.l
<br />AT:+': ".D;+b~rs ~P^r.:v_ :ryFRAf_ A'^~
<br />k
<br /> NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTE
<br />M (NPDES)
<br /> T 1
<br />DISCMAR GE MONITORING REPORT (OMR7
<br /> 91
<br />
<br /> -+n.n -. scn
<br />T nn.
<br />o PERMIT NUMBER DISCHARGE NUMBER
<br />
<br />CV
<br />0 ~ MONITORING PERIOD
<br />C7 ~ YEAR MO DAY YEAR MO DAY
<br />
<br />Q O f7O71) R2-7J) (24-251 (7821) (79-79) (JOJ11
<br />Form Approved.
<br />Y ~ ~ ~ ~ OMB No. 2040-0004
<br />Approve! expires 0531-98
<br />M1rk "' T' Sf'41Rf-
<br />NOTE: Read Instructions befo~emmplet g#this form.
<br /> (3 Cer0On UA OIQLOADING (4 Cent Ony) QUANTITY OR CONCENTRATION NO. FgEOUENC SAMPLE
<br />PARAMETER (48-53) 61 38-45) (46-53) (5a-6f) EX OF TYPE
<br />('~'Tn AVERAGE MAS(IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~'u-~1S
<br /> (ar-es~ (s4~66 69-70
<br />Cf15 DUCTIVI p- SAMPLE ^-=SFarrv ~. ~k%" '_'-'.''f.
<br />7
<br />G
<br />~ ~1
<br />J'11
<br />~
<br />( 1 l)
<br />rj
<br />,
<br />~
<br />`
<br />J
<br /> MEASUREMENT ~
<br />~
<br />c~ , 0 /L~i (
<br />~
<br />:
<br />I
<br />UD7'a4 1 7 ~ PEPMIT k##QNlrlr Rpc#~+ID~` a~~ ~~t##Rm 6~1~5 ~E:pOk(! St ' yfl/ ~
<br />~~ A~~~ -`~#~~
<br />
<br />I:FFLUr;'s1' GP'15S YALDF
<br />FREQUIREMENT.
<br />;,^R~
<br />~ i ,"
<br />r•^ ° ~ ~
<br />PR SAMPLE
<br />MEASUREMENT , fih#G~ CSR: ^•:' l
<br />'~ f
<br />7j .._~..R. ..~
<br />~ pQ
<br />C' ao
<br />( 1 2)
<br />U
<br />~/
<br />~
<br />~~:':
<br /> i~ L
<br />~
<br />UOu00 1 D U :PERMIT' = ##4lkRAf
<br />~' #tYr~?1~~ ;•'~~ •5 ~ ##tt¢1#C ~¢' ° ~'.. a( ~~ ~,>~~*' y~lt~$`
<br />EFFLUdFT GRDSi YALUI' REgUIfiEMENT ~t•~r q. y rl lr( ti t+ - ^n :=--,
<br />SOLIDS, r:,r At SAMPLE ;~t+a R# G3XZ: !'"~ ... .. .. N/~ A'/^ ( 19) ~~ fit X41
<br />SUSPENL°'1 MEASUREMENT Iv H
<br />DOS30 7 t Pt; ~~;
<br />`
<br />' ¢~~~~~ 0
<br />-' ~':? 4Qt#dl{k#. AISPAH1r,:
<br />
<br />.,
<br />i.• T - '~,"~ ~"
<br />
<br />..,,. -
<br />SE "Olf "' P, R°L'':
<br />- REO EN
<br />~ t, :
<br />- ; _:
<br />""~
<br />SOLI D.i, TJPlr, SAMPLE ~:Y :Ck3k 's ,.gt'e + 1 ( *,1 0 3~
<br />' ~r
<br />SUSPENOFJ MEASUREMENT lp.~~ 11'~> .
<br />1
<br />f •S
<br />30 I 0 D PERMIT' i0r##tl:## yg#~>Ih>x.Q ^zs0 #O~E13At` jbj i• `+ ~, ~~
<br />
<br />LOEYT ;;RT55 ebf.'1`
<br />REQUIREMENT
<br />'k;Gr
<br />h
<br />t
<br />wr T .
<br />3~LID8 SETCLEA:JL;'
<br />e SAMPLE
<br />M
<br />SURE
<br />ENT . . •".=k:=~'.: . ; 7tr, Y ;.^^~tiZ
<br />N /Q
<br />N /A 1
<br />( - 5)
<br />n-A
<br />~(i
<br />iq
<br /> M
<br />EA /_
<br />D054S D O O ~ ~~ERMIT~ ~!lF
<br />" °~~ Rtr :( ~ ~~' ~`
<br />~ '" ~~
<br />SEE COP!1EYf5 9P.LDG ~ OUIREM N7° ~ ~~•;,'"
<br />~ '! { 4LRR ~ rt it ,~~^`~
<br />SOLIDS, SEfLLBATiLF, SAMPLE a4'#O R# dOxRpQ 4OtLr##
<br />O
<br />L
<br />( 25)
<br />~
<br />3I
<br />'
<br />I
<br /> MEASUAEMENT D, I O L
<br />1 (~
<br />r
<br />J
<br />D O S n 5 1 ~ ~ `4P~9M.4~".r ^`~~ ~"~ fR+k#`!az ~~ as a ~
<br />_. w Y~ v '- s '~" ~
<br />~
<br />'~~" ~~~ '~ ~~`~
<br />EFFLUENT GP.D:S YALO° PEOUJREMENY ~ :' vr~t _
<br />~.~r ~ "'~w .
<br />,
<br />i-Y'ts>•~ S ir it -
<br />AIL E ;REAS° SAMPLE r~s7<xc ?'xkaa. ..^t r-rt+~~
<br />( ) 9)
<br /> MEASUREMENT /,J~} NA N/'~ 0.)R
<br />J 0 S 5 6 1 "• J ^` ,PERMIY` . ' ,~#*INr>k
<br />- #!§ttl~~",~ ~1 ~--o iN'' ~ ~: 4`~" ~ '~._ ~ ~ ~ ~ ~'
<br />"s
<br />~
<br />~~ ~ 1
<br />;: FF'LI)f!Nf ;;4"151 Y§L7P :REOUIREMENT ~~.-
<br />~Y
<br />.Cr. *~ Y t~, w. ~ ~~
<br />
<br />~ -
<br />.. +.v'°re .,
<br />~+"1Y
<br />NAME?RLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />ATION SUBMITED HEREIN; AND BASED ON MY
<br />
<br />/ TELEPHONE DATE
<br />
<br />S'.IChi Y!! 1'r'lljs INQUIRY OF THOSE INDNIDUAL
<br />THE INFORMATION, I BELIEV
<br />RA
<br />TE S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE,
<br />NT /
<br />~~
<br />/ I'1~
<br />/`q
<br />/
<br />/
<br />/
<br />~1.
<br />~
<br />~'}
<br />
<br />P
<br />tBj DM1
<br />l rl
<br />-
<br />-
<br />I
<br />' .
<br />ACCU
<br />TE AND COMPLE
<br />PENALTIES FOR SUBMITTIN I AM AWARE THAT THERE ARE SIGNIFlCA
<br />G FALSE INFORMATION
<br />THE
<br />INCLUDIN ~ /'
<br />9
<br />)
<br />~
<br />~ ~(~!
<br />~
<br />~~l
<br />a]4-;:7[-Z
<br />r
<br />•
<br />M
<br />,
<br />,
<br />. !.I
<br />I
<br />-,`VjrrnlTrlH
<br />I ,
<br />G
<br />POSSIBILITY OF FINE ANO IMPRISONMEM
<br />C
<br />SEE 18 U
<br />B
<br />C
<br />§ fDat AND 39 U
<br />S ] ~ _
<br />^
<br />'(~ L~
<br /> .
<br />.
<br />.
<br />.
<br />.
<br />.
<br />.
<br />§ 1319
<br />(Penettles antler Nose smlNes me
<br />Inclutl
<br />Ones u
<br />000 end W
<br />b 510 SIGNATURE OF PRINCIPAL EXECUTIVE '
<br />
<br />TYPED OR PRINTED .
<br />y
<br />p
<br />e
<br />,
<br />mevmum lmpnsarvnern of t»MSen8mmlhs entl5yeers.l OFFICEp OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND p(!'IAnAI lun ul- iAnY vwlal luny (Nererence e!r eTmcnmenrs nere/
<br />~T6R,.p rTyl°i PO? 'r; ."T!'•."?..,I~^ ;1LTn5 •,• rso n•T,v ~n n ~ ~~-
<br />c - (LOT 1 A T. ~_ _Y , rt- „-rr•r ~.Jr•,Im Tr
<br />(~ ScP I•A•2• PG !"!~ r7r `1U"?:N ~P PAO]P R5!1nI4FrIP.F^, ... 'Ti, ~ -- ----• -^-..,. -
<br />-'Ie ~ ; ~.
<br />EPA orm 3320.1 (08.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br />
|