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PERMITTEE NAME/ADDRESS (1~4. Fxtl.y Naw/LocnIm llD~i.F.p <br />NAME _', ~ ..' - v . - - - . . - _ . <br />ADDRE :~<:~ I )' 't ilia ,. '.. e v i r <br /> <br /> <br /> <br />FAatrrr <br />LOCATION <br /> <br />NATIONDISCLNARGEDMONITORING REPORT lOMR1PDES1 <br />1-781 I7-191 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM ~i a ,~I 1 TO •" "" "' <br />II4IIl !TT-T3/ !1475/ !7677/ 1T8-791 !3437/ <br />Form Approved. <br />-•-- ~ •. • - ~ ~ ~ T:. OMB~No.~2040-0004.. <br />(- „ 1 Approval ezPires 05-31-98 <br />4t ~/ "r , <br />NOTE: Reed instructions before complatinQ this form. <br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING !~ Grd Onlvl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> !46531 !54811 l38-451 /9653 !54811 <br />EX OF <br />TYPE <br />l37-371 ANUVSlS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 16T-8l1 !84681 !8&701 <br />~J .. .,. :~I'/:~''t SAMPLE .. ~.. r:::-: ~: r,-:;: .. .. <br />~~ (I ~7 <br />~ O <br />2 / 11.1 <br />~ <br />~ <br />T n <br />Ci ~A g <br /> MEASUREMENT L <br />I,:., r4 1 i ~ PERMIT ~;: ~y :: rsn ...:~{.r -. '. :"S r:::. 54ar. nnor ~. ~/ ~~{vc•^J <br />~ :Pan <br />'':..U ~'_ Tl;^ 'Ta 1,~7'- ~REOUIREMENT •::`7 7f1^B l'r^. f)'t I,Y ny ~ al•. P <br />N . <br /> SAMPLE .r h'.:'k: r:)G^': s::: t-}.. .. .. <br />~'~ ~ .?~ <br />O ry <br />7 <br />Z <br />8 <br /> MEASUREMENT !r 1 3~ ~( <br />/Q <br />UL~';10 '. PERMIT ;-~X^`: :r,~-k` R ~r' 6.{ a>~axo^ 4+'1 ~veLY ,.PA.B <br />. :[-~ - _ •~~_r, •,: REQUIREMENT ;+~ yT stTVrfSr . Y <br />F1 A <br />~7 "!nt! i0 <br /> <br />~(/L17 ;+ : _": •, <br />' <br />~ <br />SAMPLE <br />SUREMENT <br />.. ~ <br />:::G'.=:' <br />.. ~ `' <br />/"/A ' <br />1 <br />N/ <br />C , ~, <br />O <br />~ ` <br />'v/~ <br />p ; {~ <br />., <br />;~ : -, MEA ~ A <br />~JS ;7 J ^ PERMIT ~?; r.. ,- ... ~;•~ ". ` :z~!;:. o• ....~ .. ~ v; '. <br />. C;)A'1 E}~'. ~ _.1 ~a REQUIREMENT ~ -. ~n.,a eTr ~~1*Iv r..• -/. ~.). ., <br />i'..'.i ll:i+ Tr :'tl SAMPLE .. `Y'"< ;'kv~h~ ... <br />~ ~ <br />~ S { ~i <br />~ <br />3 d <br />~'' <br />~ ~.; : r: •, 7 is P MEASUREMENT ~p 4 <br />',3!) 1 ~ ~ PERMIT ik;;a'1~~.~ ..'-^-:Yf:wY,: -. ~'F T1~1R'.:': 3~ :?•~:•7 •h.-. <br />..U i:N: ~H7$ b,LII! REQUIREMENT ... ~~rp A• C~,~rt` > <br />~~ -/* '}~ <br />. ~C <br />i.rLA,--i :i°l'TL- %=?LF <br />F SAMPLE 00`x::::- r.:; .. •~,: <br />~ N <br />~ / '! a <br />' <br />~ ' <br />Fl ~ <br /> MEASUREMENT j~ A a <br />)i ~. `. U 0 PERMIT ~ .. `r,: tX; :. S'+ . r -`•::...y« !, .. Rrtvm n+r :7 : '-7 .ae _ <br />, <br />i ~. CUMH'(; !'3 R?L'1 '• REQUIREMENT .. ~ 3^^,1 38'' T'!7LY MX .1 rL .~:,. _y <br />)..iD + `: I'°LPEAC. SAMPLE ~::.` -~ r. , ^r,.:~ <br />x <br />.:.. <br />~ ~ <br />I <br />~ O <br />I ~ ,~) <br />3/ <br /> MEASUREMENT i r ~ 3 (~ <br />~:".:45 1 '-' 0 PERMIT .: t.~0 .:k{E:X0,7Y ~,,. Y:,s.'t^,}A nr Dn r•-" 1,~F(1n.. {".. ,../ "9 <br />FLU E.c .' ~q"?3- .'.T 'i- REQUIREMENT .. 7^•~,~ ¢Ilrt ~i-lv t•v f./• ~{. ;..*.; <br />_~ 1 ., A R ; :' ; A ~; `: SAMPLE :~.: ~:'~;:., ..,. ,. ; ..: ~ =r':.. . <br />- ''N F°~°~-";r' -~ -' MEASUREMENT <br />iCl _. ,`u ), (1 PERMIT 0;`".+n :: `e t;t t,:g. .. <br />, !: f::. ~• ..- -. .: f: >. t / 1.i ^? •a:.? <br />:. U c'~ •i G u 1 - ' '. (. •' , REQUIREMENT 'I-" .' . 1~ .- r . •; <br />NAMEITITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF <br />MILIAR WITH THE INFO LAW TNAT 1 HAVE PE0.50NULY EI(AMINED AND <br />RMATION SUBMITTED HEREIN; AND BASED ON <br />///~~~ TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR 111 <br />/ <br />~~ <br />~ <br /> <br />d ' <br />IIII <br />Ri <br />h OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS <br />T T ~~ <br />~~~~ ~~ <br />/ <br />!//• <br />. <br />c <br />ar <br />s TRUE. ACCUMTE AND COMPLETE. 1 AM AWARE THA <br />HERE ME <br />AMT PENAL71E5 FOR StreMITTiNO FALSE INFORMATION <br />INCLUDING / <br />( <br />'tnviromm~ni~il .''~il0r'Pr . <br />51GNIRC <br />THEPOSSIBNTYOFRNEANDIMPgI50NMENT.5EE18U.S.C.f1001AN0]] <br />SIGNATURE OF PRINCIPAL EXECUTNE ~){, 9a~-~]~~ 5 J1 D? <br /> u.5.0. f t 51s. lh+rti++,+tAr N+r mruro+m+v I•NA.r+ rn++ y+ ro t 10,000 AREA <br />TYPED OR PRINTED .ndnm++nwrr n.rpiFewrwtrwMrw++n 6/IRYIIA+W6W+•+/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY vIDLA I IVNS Irlerersncs s/r ertecnmenrs nets/ <br />L°.: P. 'Jn i .~ ~ 't' 'O' .~~. ~ _ _". °'... t', ~7L_ ~T 7:. rlt' r' TY _. ..Y rL_ ~^ ~ ._c _. .~ ~ ..- ~ n <br />F <br />~L~LNcD+ .. s tr .\t „r ..~. 1':1:.1 'tr i` ,71c . : 1~ *v:.. ~P+ TT ~. ~^-- "( '.ln. /r ~. <br />EPA Form 3320-1 108-951 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ~ ,_ ..,, t I _• , , _~ ~_ , ,~ , PAGE , OF <br />U <br />