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•~ I/p~ <br />PERMITTEE NAME/ADDRESS (Include FacilirgNprr/P/Gatation i/Ogferrnr) ~ ~ NATJONALROLLUigNi DI$CHARlj~ gg'Cfp,IlOlY,B1jSTEM fNPDES) <br />- (NAME - - ~ .DISCHA GE MONITb~NG R ORT ~(BMR~' <br />PZTTS609G b lIZ4~IX- CCIAL tlINLlG I~"16j l'~-9f EIl10H <br />ADDRESSBDd1 NINE ~ ~ (SDflH ii) <br />P.C• BOS I76 PERMIT NUMBER DISCHARGE NUMBER P +~ !'Till <br />Fdrrp.Approved. a <br />Ot418 No. 2040-0004 <br />Appt;dval expires OS-31.98 :+ <br />FACILITY OAK CREEK CU 90467 MONITORING PERIOD CSCHG TC 6CII C17CB1:/TECGT CE <br />LOCATION ~_. ~ -Y R M,O DAY NEAR O DAY ~~ <br />~ to• <br />FROM To. a a.~4 YO LI-CHlSGE ~ <br />_ <br />d T T N : D 1 Y I D L . L C 11 G ~ FI Y B' SUPT • (2D-zt rz2-x31 fz4.z5i (2s z» fse zsl (3031) NOTE: Read Instructions before c'pmpleting this form. <br /> (3 Cerd Onty) OUANTITV OR LOgDING (4 Card Only) ~OUANTITY OR CONCENTRATION N~. FREOUENC SAMPLE <br />PARAMETER (46-53)' (54•$1) '(38-46)' -(46-53J (54-61) Ex OF TYPE <br />(S2-3rJ ' ~" ~~~- AVERAGE MAXIMUM' ~ UNITS MINIMUM AVERAGE MAXIMUM UNITS _ - <br />/62.671 ANaLYSIs <br />(64-68) <br />(69-70) <br />~ S(iMALE ~CM003 ~OOftYy Ot0~t10 ( 1i) <br />/ <br /> MEQSURfiQ1ENT ~ ~~~ ~, 9 ~N <br /> ra ! s° , <br />' iFFLUENT GH059 ~lLU ,`-'Is"~- <br />~ "r c Oi+F>P - . r e , <br />. <br />OLIDS, TCTIL ; . MPL£ aovesia es>oTat~: ~ ~y*~ts4 ~ ( 15) ~ <br />USPENDED i :- UREMENT "'?„' •. ~.: L L ~ <br />I 0530 1 0 U -- . , i y <br />:: ~.OO ~; t 4.++ ;:~J- ' R' s :: <br /> <br />PfLUEYT GEIdp93 tl~D ; <br />s ~ ~ >f <br />~~~ ~ <br />~ ~ <br />' " <br />s ~~~ ~' <br />!!G/I <br />%- "` ' <br /> . ~ _. ~ , <br />! OLIDS, SET LLI9L6 S'AL`E, A?~!4*~ its • ogee • ~ ;~) <br /> MEASUREw1ENT . ;,; .~ O <br /> <br />(?645 1 0 ~ 0. ~ <br />~ <br />•g _ <br />LO! , <br />''" <br />~)~~C}'!: <br />i <br />t~ <br /> <br />~ <br />.. <br />'IIUEHT GH0+~3 Y <br />ILOE <br />,~ <br />~~ <br />~~ <br />YQ~~ ~ <br />;a.'~ <br />'''~ n <br />~: " <br />- <br />; <br />~'' <br />~~ <br />!'~ <br />dlll <br />f'"~ <br />' <br />< <br />~ <br />y' <br />. +, <br />- <br />r . , <br />, <br />- R <br />- <br />~l.'liTE, TOTlL SAMPLE r:' ,. *'~'~ Oy#0'PO •OOd>p• ( 19) / <br />r. (IS SO4) MEASUREMEN Zr ~ ~, <br /> ~ ~ ' ~ <br />" DBY2 Gxoss YILUF ~ ".zx ~ ,,t=~u ~ ~~' '. ~~~ ;~~~+ .' <br />- <br />~ <br />" i - ~i :9~` tlG/I ` R <br />a~;^ <br />• TUTI'L :snMP'~ oab;~ao op+o>ra oa~aao~ ~ , ( 1S) <br />'~" ~ <br />~ MEAS ~MENT ~ " <br />V~ <br />iD~ <br />~~1--Y ~ z"y^3 ~~~ ~ <br />~~ <br />~ ~ <br />Y <br />eri~ a-Lxn ~ 'r~~.D.' ~'~~ oa;}a4, ~ ~ .; I~, <br />1HGatf ''"l_ • '~'~, ', 'Y <br />I <br />.' i .~ -xy f,.r +4 <br /> <br />~~ •>. "1 <br /> <br />/ <br />~ -7 . <br />OTEH;1lILI DI350~~ Ivl <br />' „ i -.isc:1: +' ~ ~`• <br />c '`~ t -J.' r f,'' 1 - ,:,ji~~ 1 <br />'. I <br />' <br />1319 1 1 . A~ :. - ~ ~ <br />~ .. <br />. - ~ ~" ~ .,. . <br />TP.LUEMS GHOS YILUE +t •100 ~' <br />IL IbD GHE19B ~A~t~eE vo~+L sas *le s,sotao »taroa (' 25) <br /> MEA$U~11=MENT - „' <br />13582 1 U 0. i~SG , <br />EITLUEHT GHtl55 ll~Of r°~1 ~ r~is '` t=~~`' = ~.~~ ,lC ' <br />` flG/I <br /> ?4,- , : ~ <br />, ;;.; <br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT f HAVE PERSO NALLY EXAMINED AND ~ TELEPHONE DATE <br />AM FAM ILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MV <br />~t INOUIRV OF THOSE INDNIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br />p7(~tpJ ~1•~~TAR~IL- THE INFORMATION, I DEUEV E THE SUBMITTED IN FORMATION IS TRUE. <br />ACCURATE AND, COMPLETE. <br />'SUBMITT <br />O <br />N <br />- I AM AWARE THAT TH <br />FALSE INFORMATIO ERE ARE SIGNIFICANT <br />NCLUDING THE <br />N <br />PENALTIES. <br />q <br />I <br />i <br />POSSIBIf-f ..OF'1`IL~E AND IMPR <br />' uu under th <br />' § tat 9 . I <br />G <br />ISONMENT. SEE 1B U.S.C. § 1001 AND J3 U.S.C <br />tines me <br />include fin <br />s u <br />t <br />000 end a <br />St0 SIGNAT.UR INCIPAL EXECUTIVE '~ <br />ese <br />. <br />' TYPED OR PRINTED msrim0 Psonmenr of 6etwe y <br />p <br />e <br />o <br />, <br />6mnnthe ena 5yaars.J OFFICER OR AUTHORIZED AGENT ARE <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> GOD ~ <br />i <br />~~ <br />rU <br />i <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS erence all attac ~ nts Here) <br />TSS E TCTAL IHOH LIE.ITS liIL E WIVE ;AHD SET4LFlPLE SCLIDS LZlIIT IEELIED FCB <=10YF, 54EF FFEC.IF FVFI+T <br />~~~LEB I.l.2, P YI PCH [ETIILS. CHTHLY AflEI1NG IISTH,CTICNS - I.C.9. dflTHCC CFIEC7ICA IIh1TE - I.l.i• <br />... ~ , <br />. EPT/1 Form 3920-1 (08-9 (~~ revious e~ilion5.m~y not a sed. ~ ~(R S - AV NafiBE S C 0 i Z ~ / C Q C 1 1 1 _ 1 f, i ~ A I O <br />.y <br />