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PERMITTEE NAME/ADDRESS (!wa NAME ^-~1'D.:. 1jS r.., ADDRESS " : 1, .: $ I , ~ ' i'' ~~t /o e.n?r •6 Fenl~ry Nadlncaum dDrp...nq -~ - `AL CORD. - E iJ Ay i • _ T ^ • r ~_i -~ > FACILITY LOCATION .,'::,. "036'?', ^t :- .'!:r':0.1. o*':'r NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM lNPDESI DISCHARGE MONITORING REPORT (OMRI l7-161 17-191 ,'~1''-l tya I'.'1n 7 PERMIT NUMBER DISCHARGE NUMBER MONITORING PERIOD YEAR MO DAY YEAR MO DAV FROM !'1 ~? ~ t TO '+n ~~ ~ ~~ 116111 lZ1-131 124151 116271 128-191 !343/1 Form Approved. .• . r c i ~ ~ ~~ n -~ ..rOMB~No~2040-0004 ;. r Approve4 expires OS-31-98 o _ "' , Ai ~. 1_;. • NOTE: Rs6d ImWetloru belora compbtin0 this form. PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !I Grd Ontyl QUANTITY OR CONCENTRATION NO, FREauENCr SAMPLE !4653 15461 l35-<5! !1653 !546/1 EX uy TYPE l31-371 µ yg AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA X1 MUM UNITS K=.691 !54681 159-70 1 I"?\E ro'fAL SAMPLE '~^:;: ".'r !''r; nt: :: r: r....:. .._ 1` ,~ ~ { l ll ~ ~ y / J { ~ ~~ F :,) MEASUREMENT 1 !V ~~ ~ i 1'7115 0 PERMIT `r'g pm[: rFn:,y .~~O : ': -:~ .'-S'r:t-':X: 4F pr)am T, r. ~n-."^ ly~r~! '?AF Cn1*. ~'4 r.i Hv11-~ REQUIREMENT. 4'F~ lf1ltA AS.^• [3`TT4 InY ~'/1. M 17 ~~i j •l.lS, ?'OrF.L SAMPLE ry0O'.-: r,0 Cr.C ^r rj'.a C_.y:Y r..~r: ~ { T~~ ~ /I /J ^ ~'~~J { A ri r •_: j MEASUREMENT E F C C it-ILLS 1 O :1 ..PERMIT .^,..;s~a.^,'.k~ - L~9~d08Et 9 d^t 5drnitxe^ ~.S ~ 7Fn I Cj'~~.. it14.? r~L;r r-..;m -~n"_- yeT'I: REQUIREMENT - - ~ .'.: t:'-h ~ Z^}'. 11 ~A 4". ?1R T~L~' R'Y 11'"/L #4 (Y!: ^`#~ r U: • F I N CI)K r: ,. •* .~ SAMPLE / { J 3) {:.•-Y-•..: :° {: is^.~#:;- r•. p': r:~^ "i :..'~i i'Y F;ATMF--~~-' "L",; -f MEASUREMENT OFO~y - rolL(/ ~ 3 '~C^"` t 0 ^ PERMIT RF:P1?r }pTI0N1L Ct~Afi V~~:f~'s:"... sp+e?l..y;.. . .~.,,. I ^?Y-[,'/ {I"~$~" '°L IFwT GROSS Yf i.'1` REQUIREMENT 3DDA:.Aya ^,RIL'! `!R N,^,D ti`'"'° iii A!; f• ,: Ii 745P. SAMPLE 4R O4R~` { 94) ,: eY:.....t ,y :r:.., ..~:... .- ~ ~ ~T, ;' i';'; 3 L MEASUREMENT n P' ~.. .. -. ,i i ;j 0 PERMIT ~ ^C':'~".<"Y it a .:'x. cr..l .,- 'q hir: Y: k W~ ;..Y w.Y ..:... 7.w, Y.H+,`. ?: :!:':.'. I P av v L. I I. TS .K.I. - -, ~ I r• `; : p ~ i 5 Y A t n t REQUIREMENT i~ Via;' K 4 v r; i ;_ ^ ... SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAMEli1TLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENN.TY OF AM FAMIUM WITH THE INFO LAW THAT 1 HAVE PERSONALLY E%AMINED AND _ TELEPHONE RMATION SUBMITTED HEREIN; AND eASEO ON DATE MY INDUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP I BELIEVE THE SUBMITTED INFORMATION 19 OBTNNING THE INFORMATION ~ ~ - /~l ' f 1 rich~rd n115~S , TRUE, ACCUMTE AND COMRETE. I AM AWA11E TNAT THERE ME TIES FOR SUBMITTING FALSE INFORMATION INCLUDING FICANT PENN ] /~. C/ ([.f'~,~ /`,~(('y Envlr:tr+mantal 'll2 i'1%C(OY , . SIGNI THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 1e U.S.C.I 1001 AND 33 SIGNATURE OF f711NCIPAL EXECUTIVE 4 4 ZB 9~ U.S.C. f 1316. lPrWAb IMY Mr AbNhA /rrY 41CA.dE FMYAW ro 110,000 M AREA NUMBER YEAR MO D TYPED OR PRINTED .Ad nmuimAn hrodonwHMMnrwn Qmmen rW 6 yrn.l OFFICER OR AURIORIZED AOE CODE AV COMMENTS AND EXPLANATION OF ANV VIOLATIONS (RI/IrIOCI M/ s/tschmsn/9 here! L' ,~1." L? c'' ._F _ ~ °.i-'.. ,rL' -'1LT PF {j.~_ rn~T .'nTv ~.~.7 T^ (- ~n_v':E ~rl_ -" ., CLl:^:l;~ ~~:~ 7. .~• .'E ^'l• I?")F.. ^: ~_-~~ - .~_ pvp`.. ~ nTr '7r ... _-rc c^n^. -. :IF fir'. .. _ ~r ~r^ ~• EPA Fwm 3320-1 (08-96) 'Previous editions mey be used. T (REPLACES EPA FORM T<0 WHICH MAY NOT BE USED.1 n n ,~ ~ ~ ~ n n ~ ,I i~ 7 _ 1 r ~ n PAGE _ OF J +~.~~~ ~t