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< -~ s _. _ ~ ~ a l ~ ~~pERMITTEE NAME/ADDRESS(1nd.b Fmu~ Na.+/Luauai D ry I/ Ufrnw) ~~~ - ~ ~ ~ 1 NATIONAL POCLUT`ART OIBCNAAOEELIMINAION SYSTEM'INPDESI . - - - EO.IR ApprdVeQ. ~ ~ ~ ~' ' l -.~- NAME K t k.t ~ J'. L ~ J ~' 4 J 4 DISCHARGE MONITORING REPORT lDMR1. a-+5 rr7-rsl 8 No 0 -0 04 ~ POIfD F/TRIG TD Ck~J~~~i'~.~L~ 05-3 96" ~! ' ADDRESS MA d:i f1T(t-~ :U'o gg D037 UU -- (SURR NY) pprovel EplrPe t P. 0. d J K 7 1 i 'l r, ! PERMIT NUMBER DISCHARGE NUMBER p- F I 2! A L ST ~A'1,1JA: ..-TV;i ~J 3J11/ `1IR03 ~ - FACILrrv MONITORING PERIOD YEAR MO DAY YEAR MO DAY LOCATIONMAL'J~N ~'.) '!J'1 :4J FROM VI l 1L TO U W J ~~+ NG CTSCIIAR:,E X •^,: i'~t ) ~ ~ 9 I' ~f A : u G J .t :: t J . !' •. " I' Z `, ~ .) + + ~ I i5 " .- 116111 111-131 11N51 116171 l18-191 l363A __ NOTE: Reed Inetructlarq before completing this form. PARAMETER !3 Gre Dnlrl QUANTITY OR LOADING !I G+d Onrrl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE l4G531 r5d-611 I3B-451 !4653 r54-611 EX 131-37/ µKVS15 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rBZ-6Jl ~ 15d-6Bl r69-701 L'r! SAMPLE ..~, .-~~lrr ... r~ ( 12j MEASUREMENT ,IJ4.1'.1 1 U U ~ PERMIT ~~~ Crr-dam' G5+4cAxTF ~. ~,.rj. ~' #>ri:IG ~# q;Q ~~ Efi[TLi .NSirU is k'"r LU E.. 'f URCS:i YALJ;: :RE¢UIREMENT ~ #~~t :t 7Idj~A.UH~ ~ ?:AYZMti fS ~ SU --, i.l ..I :'S/ S;;T!'LC'. '1iLE SAMPLE .,,- F.`•YR,^ 4;F 04: L`=.r .c3? 6y (. Zrj~ MEASUREMENT J:J )4) i U U ~ PERMIT .:;;:?/tom ri~Y~rC ..,- ~ OQ:?it tit$'. •#~d4 ..p. ~erJ~' ~: -~.::. ( ~t11r Y./ ~ ~H~~B. r.rFLUENT ,;&USS VALUK REQUIREMENT #;=:a ~ DlZ ~~1 'l~Y~ +L/L ~~ 'i1b~N .7iL AHO ukEAis SAMPLE .. .. ,.rt;: :.`• .;:4f#~ +.-.r ~Ra ( ]. ~~ MEASUREMENT J1~ul 1 U U PERMIT .Cxk?: ,.YpR:: Vhf adaaav is#;:d # 14 ( ©vTlal )RSH „F'FLUF':VT SkD55 VALJ.`~. REQUIREMENT CiY a DAILY I!g 17C/L BENT i L.1M F IY C7U L'J f f ) l SAMPLE ( !)j) ,-.;, ,;4 ;l--;. ,f~l`• ~;: aYA t<^.. ::+r - fY.U rnEA rrl e.vr PLA~:T MEASUREMENT ~UJ~U 1 J U PERMIT PT*JNAL iICPJtlT '~Jr1rGv' 'r-"+•".=-F '~F "-Y+M#ir't = ':'+:'k ( r1.'-f!/ :k~$I'AY Ef'r'LUENT 6RU55 VALJZ REQUIREMENT 3UCA AV3 BAILY MX. 0GD }lDNY:i 7IL ANU ::SEAS!' SAMPLE =f 3'.`-:, ( 9~~ ...Y4'ru ,-:: L: .. ~k;=^k:': t= J 1~ U A L MEASUREMENT i IIUUL 1 ~ J .PERMIT ,-:=-.'saa ~3EPDKT Y ES=I rda.a v'k# Y#:r#~ ~ .~.##.a~.~#:= ~ :F::a r ,y^E/ ISU4L ~:Ff'L'JE~T ;,RJSS Yl,L:JE ;REQUIREMENT INST NA:S NO=J #%~-- y0[+Li! SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT 'REQUIREMENT' NAME?ITLE PRINCIPAL EXECUTIYE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EAAMINFD AND AM FAMIUM WITH THE M/FORMATION SUBMITTED HEREIN; AND BASED ON / ~ TELEPHONE DATE M.~., Richard A. jhQILBOII MV INOUIIfY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR I OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS / ~/y//y// ~1~y~ //~ . ~ YiOe PreBident AONIRCANi PENALiµS FOR SUBMITTING FALSE NORMATIONTNCLUD ND , ~ ~ ~ / ~~/' "C'"~`"-G"- '~}~'r~ y1~r~ 21 Z QO ~/• 0 7/V rv/ / 7 THE POSSIBILITY OF FINE AND IMPRISONMENT. BEE 1B U.S.C. ! 1001 AND 93 ~BIONATURE OF PRINCIPAL E7EECUTIVE TYPED OR PRINTED ~ U.B.C. ! 1315, rhnMU.. urM.r Nrr mnm. IrnY Nchd. 5ws W ro s IO,D00 An/dmvl+wn MAViv,nNnr o/bMwn6menN.w6Twa/ ~ OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR MO DAY COMMENTS AND ExPLANATIOn OF ANT v1ut.A I luny r+rerersnee sn ertscnmenre neTel SEf'fLEABLE SULKS LI'7If IIAIYED FJk LC-YR, 2q-9N PHF.C[:' ?>IEtsl' ~U_Jd„'f TO HURCEN JF Pk^:~i' R3pUI~t~'t!!.'f'~ CV P11t1' I.9.1.CF P. rF STU39iAT"'.N RAVA~E98NT PLAN DUE 1-1-a'. ! EPA Fpm 3320-1 108.951 Previous editions may ba used. IREPIACES EPA FORM Td0 WNICH MAY NOT BE USED.1 U 3 J 1 / 31,1 H 19 -12 i ;1 PAGE L OF i