rT:NMll lkt NAMk/AYUncsa u~../+....••~••+.~. L..••~•..•v•w• ~~~~.
<br />NAMi/d_,C~'W.iUS EMNII:L CUr:)'ur:al luN
<br />-Aaurv`CYPItUS I;@MPIkE CUKF'U~cAT lUN
<br />LDCAnDNOkAIi; CG 81629
<br />ATTN: MICNAtL w. LUDLi:IV. GLNi=k;.L t:;~j<
<br />NNIIUN. .. ~ ..-u.... .. ~ ... .. ... .L 1... ........J.V .....~...1 .. /L~/ rJllll /~pPloved.
<br />DISCHARGE MONRORINO REPORT DA~RI / , Oa,rB N 71040-QOQ4-, q
<br />1-re n-IS r. ...~L ~U oN-9Lw TU 'T.<~FI''.
<br />1)u 3r / (3 .3 Approve) a pl ep 85-fit-98
<br />SUHk Nii LLr~~~
<br />PERMI7 NUMBER DISCNMOENUMBEII r ~r [ KAL
<br />MONITORING PERIOD M I (J(Jk r
<br />YEAR MO DAV YEAR MO DAY
<br />FROM o TO - Y './ ,; ~}{'{' Nu UISC(IA1;41 ~{'{`+~
<br />110311 l11-131 111-161 ~ ~~ ~ -' !2617/ I1A-1Bl 13x31/ NOTE: Reed Irutruetloro belore eompleElnp Thle form.
<br />PARAMETER /3 Grd Ontyl QUANTITY OR LOADING ~
<br />' !I Grd OnlFl QUANTIT1f OR CONCENTRATION NO. ~EODan' SAMPLE
<br /> !165 /54-6
<br />/ 386 4663 61-6! of
<br />l91-371 ~ EX MALY99 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re:-em 161-6a~ /6s~o~
<br />'N SAMPLE
<br />ME
<br />SUREMENT {. {. .rP{.¢ VM,}Y.?I {. I
<br />~
<br />Z .f ..:.{. {. .. II
<br />(/
<br />'
<br />'
<br /> A , ~~ z G ~~~ .fir:/\I
<br />;
<br />JU4UU 1 0 G .~~~:: PERMIT ~:~~: ::::.. ~;1 ,(~Y<~~if: :.~ .;, :: ~?~I Eta~Ci ii~rir ~~. r..a ,~:.:~: ::..,<t.>.~:,.. ~ti<:';~.:~ ~.i ~l
<br />,
<br />_FFLUEriT l+FUSS YALUi. REQUIREMENT; '.: ..`.,. :. :- .:.:: .::::.: ::.:' til:d 9Ui~ ..: t:;s~ `;1~ t :. ,U J:.
<br />M:: t :..
<br />~LLIUSf Sc1TLcASLL SAMPLE y¢,}{~p:< {.pr.:a{~:< {.¢{. ,:i<{.
<br />~
<br />~~
<br /> MEASUREMENT Q ~ L~ r ~/I\I?.
<br />~OU4h 1 U U PERMIT. .. :...;.;.• ,;<:. :.'I,.;. Kvr ~
<br />.
<br />.. :. .
<br />~:
<br />.:.
<br />d., t.`.. t.. (j~:T:
<br />i.
<br />'
<br />' <:i::
<br />~
<br />; ;(
<br />
<br />`' 'i~f;c:/: :. 'i~R:
<br />..FFLULr•1T L,hUSS VALI.IL REQUIREMENT
<br />.... ... :. ..:..:... ~ :
<br />::
<br />.
<br />':. ,' .:.::....:::.. ::~;.{, .;
<br />'.
<br />:,:.`i/,. .
<br />.
<br />,'i_:..
<br />:~. .1 / ti
<br />L,;..
<br />JIL ANU !,!{EASE
<br />hhLi]h Eft Tri-GitAV McT) SAMPLE
<br />MEASUREMENT {...{.,.;..; 4M.}{. {. r. ..,iVY{~:• :•{,:•;:.•{• ~/~ Iq 0 f\1/~ raj
<br />
<br />u U ~ 1 U U
<br />P .MIT ::
<br />S. S' k.';..:.:. .
<br />:::::.7 t. 7 ? I(r x~ ::%
<br />. a', : i<i a t
<br />, .. f,u.:. ~ ti .: "i ',';.. {<:,~...
<br />:. t..: e:.:.:
<br />1 J ... :::......
<br />
<br />(
<br />
<br />
<br />;. .
<br />r
<br />....
<br />rrLU~rll (,kU~S Vr,LU( :REQUIREMENT: ~ :: ~.
<br />:. :. ..
<br />..
<br />-,
<br />:::.:....:.:. .:
<br />::
<br />.
<br />.::.
<br />:::: :
<br />;:
<br />;
<br />1
<br />aSi
<br />4
<br />X
<br />G/L .
<br />:~
<br />i
<br />r
<br />~
<br />- .
<br />,.
<br />, . ,
<br />.
<br />.
<br />. . :
<br />:...
<br />r,
<br />< ,I ,.t T:
<br />rLUHF IiJ (.IiNUUI I iii{ SAMPLE - ,~ x~_---.
<br />' U3 fI\.V'f4<4 . ."•:~ti~d i'%f !. ,: .:. ;.
<br />3
<br />1 NKU TkLAI MINT i'L.aJI MEASUREMENT - __
<br />_. / ~G
<br />ll ~ p 96 NcTiln
<br />~UU7U 1 U U PERMIT: ..' w.c}'!iTl{T`: '::`a<L:?t1n:
<br />~ '7•'r.u~•S<y1<.:. :::.:.:A.;e:......
<br />/:~~ '; ..<:. °. a. :,
<br />:::';'( Fi 5
<br />•P by ,~
<br />- v .c. ,
<br />r_FFLUtNT U., U., ., V aLUl REQUIREMENT
<br />.:..:...:...... :_ L)liA :::A.S°~ . :.:15A liY:: tTX; IUU
<br />....:.;.: ;:
<br />
<br />~I:Ji T.l1
<br />
<br />::.. ....
<br /> SAMPLE
<br /> MEASUREMENT
<br /> :~':.:~ PERMIT:: ~ ::. .....:..
<br />...
<br />..
<br />.
<br />:
<br /> ~REQUIREMENT~ . :... . ..
<br />. .
<br />..
<br /> SAMPLE '
<br /> MEASUREMENT
<br />~
<br /> .;..:~'PERMIT::...::
<br />. .... ....... :;'..::~.~ .:':::~::.;.;::;.:'.
<br />.. ... ..:.: .........:: ~~~.~::~.:: ~
<br />.
<br />:,.,~::::::
<br />~~s
<br />: ~ .: :.
<br />.::::.
<br />...::.::.::...~.:~.::.:,:~:
<br />::
<br /> REQUIREMENT: ... :: :
<br />.
<br />.::.
<br />....:..
<br />...:......: ...
<br /> ;:::
<br />..... .:. ... ~;
<br />:.: ..:
<br /> SAMPLE
<br /> MEASUREMENT
<br />' .:::.;.FERMI ~ :..: ... :. ..:.......... ...:...::..::...::...... ...
<br />~ . .
<br />
<br />.REQUIREMENT'
<br />..: ~::~~~::;...::::: ;";<:::::'.~~~ ....
<br />~~"~~ ~:~::~ ::..::::.::.........::::
<br />...:
<br />
<br />. ;...::
<br />:.:.:.::...;.:..:...::.:..:::
<br />
<br />... ....
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER 1 CEAT
<br />AM fA FY UFIDFX PENALTY OF
<br />MIl1M WITH THE INFO lAW THAT 1 NAVE PERSONALLY EXAMINED MD
<br />RMATION 9UaMITIFD HEREIN; MD BASED ON
<br />TELEPHONE
<br />DATE
<br /> MY INOUIIIY OF THOSE IRDINDUALe IMMEDIATELY RE9'ON9eLE FOR
<br />'
<br />
<br />RlChdrd MIIIS OBTAINING TNF INFORMATION, I eFLEVE THE SVeMITTED INFORMATION 19
<br />TRUF
<br />ACCURATE MD COMPLETE
<br />I AM AWME THAT tNFAE ME /' ~~'1 ~;
<br />/~ f'
<br />,
<br /> .
<br />.
<br />90NIRCMT PENALTIES fM SUlMFTNO fALSE INFORMATION
<br />INCLUDING ~
<br />J • (q~QIaTQ~'l7TZ 4 27 9R
<br />Environmental anager ,
<br />THE P059MLITr OF RNE MOIMPRISONMENT
<br />SEE le U
<br />6
<br />C
<br />11001 MDia ~-'
<br /> .
<br />.
<br />.
<br />.
<br />u
<br />s
<br />I rare
<br />ld
<br />s
<br />c
<br />w
<br />w
<br />~
<br />A
<br />s
<br />IE
<br />rO
<br />o 610NATUIIE OF PRINCO'AL EXECUTIVE
<br /> .
<br />.
<br />N,.
<br />,.
<br />.
<br />.
<br />.. lo
<br />r.. onnw mw
<br />,r
<br />,
<br />.
<br />Ir. y . t
<br />,a
<br />O A
<br />TYPED OR PRINTED rM ernr<I,lun i/pbwrNd MlwPw 1/nmdM AM6Fera/ OFFlCER OR AUTRORI2ED AGENT ~,OpE NUMRER YEAR MO DAY
<br />a.armmcn I ~ nnM cnr ... ............. ..... .........~..~ ............ ~. ~.....................
<br />SETTLtAE1LL- 5UL1U5 Llt:ll NAIvcU fUk IUYkf24M/{ P•{ECIi''[YcI~T-SET: 1.A.lf 1'i, iV, F(,,: I;EUUIIie.r(LtJTS. U[l. v
<br />L:RcASE U12At! SAMPLE Ardl,Lf:~[. iiL~UlricU IF VIS[3LL= 511r.i)J I5 llriSEKYLU< vHTrtLY 54Mi'LiNt; 1(ISTkUCTIUNS-l.C..df
<br />EP Form 3320-1 106.96) Prsvloue editlone msy be used. (REPLACER EPA FORM T40 WNICN MAY NOT BE USED.) I I ~ , / / : / 1 111 I (- I ~ I I PAGE ) OF
<br />
|