|
PERMITTEE NAME/ADDRESS (/rvlldr FrWryNa/focanen UDr$•..,0
<br />NAM
<br />E. :~-yIP". Vr ',r ~r• ~ -r ~ •1']•
<br />(
<br />
<br />
<br />
<br />fACILITV
<br />LOCATION
<br />. Iwi 1: i ~ iT I -~A' ItTy'r
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATON SYSTEM l/yPDE$1
<br />DISCHARGE MONRORING REPORT lOMRI
<br />l1-161 117-191
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM 1 J 'li ~)? 70 n~ ~~ ~~
<br />114111 l22-131 114151 126-271 118-191 !34311
<br />.,r. } ..~.~ n
<br />[„ .. .~ 1~
<br />1` ~ ~ r Y
<br />. f _ -...
<br />Form Approved.
<br />r YOMB~No~2040-0004..;,
<br />Appro4el expNae OS-31198
<br />L ~1 e
<br />NOTE: Reed Inetruetlone before eompbtlnp this form.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !1 Grd Only! QUANTITY OR CONCENTRATION NO FREDUENCY SAMPLE
<br /> 146-531 !5461/ l38-451 !4653 !5461/
<br />Ex GF
<br />TYPE
<br />!3237) MA1V515
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167.6J1 164681 169-701
<br />:4'+N, T.:"'Ar SAMPLE
<br />RE
<br />E
<br />T .::ra;:r: r.^~Y:}tit {: !;;ogh:}
<br />J~
<br />,I 1 Irf
<br />( 1 '7)
<br />~~
<br />~ Ly
<br />( .. ~
<br />A ~ MEASU
<br />M
<br />N rl / V TI rl
<br />Ii l'1iy5 n ~ PERMIT. s1:klc~4 ItC,Yngt: { .r~Y ^•,;y3Jy. DP Cry?~• occn••: t tti^E/ :R,.'
<br />;t'-: CUR' .,"._ .:'~Ll•I REQUIREMENT. Yr ti; 70PA A~V^ T6 T'[V NY' ~~~ !4nN4`R ~ .
<br />]i?i)N, TII~_„L SAMPLE
<br />MEASUREMENT ^-70'kGC< ;r::trFt:'.r rtttifi-•••• Q
<br />I
<br />3 ~ 1~~ (
<br />/ /J II,
<br />l
<br />•
<br />( t, ~ f I , 1 .
<br />f7Y
<br />:::745 1 7 'J ~~ PERMIT. ;YS:.O!,~5+ ~ ~.:*xRQ4=b:~r ~ cya 0~4#fit, 3.S 1,'n ~; ~prf./ .itlt?
<br />`'FLIJEN'f "'°~ VAL'J; REQUIREMENT ~,.,!. IRpA E4" ftOTiY r7 .~/[. NFIHTH
<br />°L'«, I"J `^.,nUTr nt• SAMPLE ~ ( ~]) tyn--•: t. ;:•Y;:^^: *.>:.,.... 1
<br />(
<br />is 't r ~s ~: A r h e n r P L^ "' MEASUREMENT •~ Q J ~/
<br />5li'..a0 1 Q ..0 PERMIT Rt?AZT. ]PTI7"AL 2r,.#r/Lr, rt:':v):~,p;; r (r
<br />c:.`.J~NT GR~5.3'~!•:.',•r REQUIREMENT .:~~~ A4: DAILY ~!:{ +~!:1j •••.t
<br />iIL AND G"n?TSP SAMPLE 4'M~::~^-: ( ay) rt'.+•••:±, ,• :ri.~•..•:. aR'n•:'r'r /
<br />
<br />~; ~ ; ~ } L
<br />MEASUREMENT ~
<br />/ ~/
<br /> A /
<br />1.
<br />4.:K6 R U PERMIT ~•'.: nr--;: T
<br />V~
<br />^ c^c1 !: OyYO(r01 ..-. t!Y ": ,', .... My..:.•; ../ F~..4'T.'f lI^`!7 !.
<br />--i.J ii'i'. ;4~i~ VAGO' .REQUIREMENT .~I [25:11~~
<br />'
<br />Ar ,'~=~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT'
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> .PERMIT
<br /> REQUIREMENT
<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I NAVE PERSONALLY E%AMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />~(i CiTa ru lil(~(5 OBTNNINO THE INFORMATON. I BELIEVE THE SUBMITTED INFORMATION 19
<br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIONIFICMT PENALTIES fOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />~RV~I'DTt ITI@f?t<3~ ?:(a pacer ,
<br />THE POSSISIUTV OF FINE MD
<br />MPR
<br />SONMENT
<br />SEE 15 U
<br />S
<br />E 1001
<br />C
<br />D 7D $7
<br />71 4
<br />
<br />.
<br />.
<br />I
<br />I
<br />.
<br />.
<br />M
<br />31
<br />BIONATURE OF PRINCIPAL EXECUTIVE -2
<br />? ZR t19
<br /> u.s.c. f r alE. lnNlrw, r,lwr U.r mnm, my McAd• w.s Ip ro t r0,Op0 AREA
<br />TYPED OR PRINTED .••/armu~m,n YrNrltamwrrraMr•,wn emonn,.nds yaval OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO Dqy
<br />CDMMt:rv IS AND EXPLANATION Oh ANT VIVLA IIUrvs !/TeTe/enCe M/sf(eCOmenr90e/el
<br />. .,. Dk!.T:. IT"_ -' .-~, [--I .1 ;g7TL'.nr_ -.~L.... c; (L1.• r~t1 !^~LY ~'I,'! rr i_ ~ _vr '1 ;_qp ',r'.. !-
<br />'r
<br />. • I ~ ~ i • ' . '' - • L • -' , - i -1 , p l• D - I '? '] f -" 1 f [ '7 "] '1 C i"• l l ~ .'r C Y C V T ^ • r1 T ~. P /' •r • . !) '•. - ~ t l' ~ n ~
<br />-r.rv nr r• ^r
<br />EPA Form 3320.1 108-961 Prevloue edlbone mey ba used. T (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.1 ~ n r),t F. / ^ D n rl n ~ _ ~ ^ ~ , PAGE _ OF
<br />.1
<br />I
<br />
|