|
PERMITTEE NAME/ADDRESS p.~Yb FxdlryNaw/Locanm UDlS..rN)
<br />NAME .;YPR~:r +"'+ YALLPT '7AL :']~^
<br />ADDRESS .~NG.. F.'. i .--?'iTUF ~ ~'^K°h' 7~
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTMT DISCNMGE EVMINATION SYSTEM INPOESI
<br />DISCHARGE MONITORING REPORT IDMRI
<br />17-161 I7-191
<br />':,0027117 rl~
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '1 'I' '). TO '1 '~~ ~'
<br />120.211 /22-231 I21-261 /16-171 119-791 136311
<br />... ~ nnvl• F.
<br />r
<br />(-!~O NA~
<br />r• - ~r.:
<br />~. a
<br />Form Approved.
<br />T ~OMI3-No,,, 2040-000,4. x
<br />Approval axRires 06-31-98
<br />x NOTE: Read inetruetione before rcorgpletinp this lorm.
<br />PARAMETER !3 Grd On/YI QUANTITY OR LOADING !4 Grd Onryl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br /> /46531 l5L6'l1 /38-451 146531 /5461
<br />E% of
<br />TYPE
<br />132-371 MALrss
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS ls7.e.Tl 164661 169-701
<br />..I SAMPLE .: ::r`-.~ ~. r . .- . .. ( ~)
<br /> MEASUREMENT
<br />G ~J00 1 ;) •~ PERMIT 4:'s-t##? ..^-;.:••;;# [ .~.. h.7 ,..':#C::; •-~~n g~'K I.v -Tii ii
<br />:Fi',.U3LT ;R']°.'. VALUF. REQUIREMENT C.:`-?? qj uTyn~!. nllYT'+S!`!.
<br />u..IUS, ,rITL~:A ILIa SAMPLE #t~x•=#? .,':4^:~ . . .dt# ( ')5)
<br /> MEASUREMENT
<br />~1:;'L-. V b 0 PERMIT '~#R.k4R ##ar,•t# O r,`t S<#~'#III'~C'~: R°V'1F^.' ~ R^PnA'" I rMC'€/ %AA9
<br />~i I:JF!!!c,y"n5 ft°.L~': REQUIREMENT '.=';k0 ~ 7!]nA Syr RI.T~L~ .ey `17/I. :'77H'I,'!H
<br />iUL! D_i, S` "'TL':4yI •. SAMPLE :... .. :Y :k;:'k"A 3'.`. :'.: `:" ( '?~)
<br /> MEASUREMENT
<br />] _ ~l ~> 1 ~ ii
<br />PERMIT
<br />"-'~=,.-.-
<br />Yt :". x ,. r~ r
<br />',GL.# '4
<br />{-:` .a..,l,':
<br />': :g .,... D •' nn _ n n r
<br />, r s
<br />.?r .f
<br />;RA9
<br />.'~'LUr'.NT GROSS nr- REQUIREMENT. ##:Y "Irr IE E'~'' ~nr;Y ~Y ,..~I "")?'T:r sr
<br />.)i :. A:1 C; oR F.A. F SAMPLE ~ .. r~ ^.•:`## .. / n1 ~•
<br />.-. J': FCTR-G~~A" - n': MEASUREMENT
<br />.:0~~~ 1 D (t PERMIT OKafixY3 r#t+''.#x ;. .;. fir..;.;:...: '::t-. r. ~`I1.I'J :?+(.¢3
<br />~F'C.Uis?T 9ROS" V81. `J"• REQUIREMENT ~ c0 T`I •'^: raY "/C, ~'uT
<br />'L :J,, IN C7ti n~~!r f)A SAMPLE ( J7) ±,.w.; .. .. ~, ... ,..~...., .. :. ~: .--_-,.. ;:
<br />Lil ~~'; f?;ATM F"" n(,AN MEASUREMENT
<br />~JL"-~U 1. r' PERMIT i?E?aR'~' l~~i'IOYAL X{_i`+sJ!Y,tr -,-. ..., ..... ,Y',t :'.:~~:,r ,-.v '+I ~'Ta'I
<br />'^FLU'.i°.T . ?": ;'; YAL'IF
<br />• REQUIREMENT 30bA APS 7AIL'L MX n;;t
<br />{. AND ., ... ,. SAMPLE :,g g; r.. ( 9Y) .': r:.... ,~ ;, •. t: t.. .:fi+•y .•:
<br />V .L ::,U 4L MEASUREMENT
<br />a :Fh 1 " I' PERMIT ?r:•.='k ;r :` ~ l y a5=1 .-,-:`.:'s:^e:!: .. -. #Y. #.~~t I c. ,,, ,.Y '7'':S (.
<br />5~~, '7!LyF
<br />''LI;c.
<br />.-•' REQUIREMENT C'IST MAX [i7=0 ~ -
<br />.
<br />..
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT.
<br />NAME/TITLE PRINCIPAL E]fECUTNE OFFICER I cERnFr UNDER PENALTr of uw TNAT I NAVE PEFSONALLr ExAMINEO MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON _ ~~ TELEPHONE DATE
<br />
<br />I.-If l~i~)'(~ I~ISII~ MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INF011MATON, I BELIEVE THE SUBMITTED INFORMATION IS
<br />I I
<br />A1 AWME TNAT THERE ME
<br />P
<br />ETE / /
<br />/
<br />/
<br />~naner
<br />ental
<br />'
<br />~
<br />L- TRUE. ACCUMTE MD COM
<br />L
<br />.
<br />1
<br />INCLUDING
<br />SIGNIFICANT PENALTIES FORSUBMITTINOFAISEINFORMATION '
<br />r
<br />u =/(,-`/~_17]~ ~~ ~~`
<br />i
<br />1
<br />Dnn
<br />nv
<br />'- ,
<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE le U.S.C. 1 1001 MD 9] SIGNATURE OF PRINCIPAL E%ECUTNE
<br /> U.S.C. f tS10. lAnWrM. urWrr N.~ wNh. rnrY /ntkW ~ •W ro SIO,OOrI AREA
<br />TYPED OR PRINTED ,ndwmnrdwnerrm~.wvrw+raa.n.«nemwrn.wbYW..I OFFlCER OR AUTNORI2ED A0ENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLANATION OF ANY VIOLA( Ions lxererence sn arncnmsnrs rorol
<br />F ~ I r i T . _ ., r [ E p s ~ r [• 1 '; - ~! o " 'i - ': ~ 7 a . • r -. n - -
<br />S~.TL.. ., ... ', L~- .7 (L7~ 1 L7 ) ~ -' -. - '-L'7' '. -~ i. .'
<br />.; IT:, ~):'. t•'• ., l,1 ~ ,f(7'•C"'`:T ~. 7I'. e rPCt, i--r- v,9.~• , m, v/F ~ .'iY r.CI. .. ,
<br />EPA Form 3320-1 108-96) Previous editions meyrybe used. - (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) n ,~ r ~ ~ ~., .~ ,~ ~- I r ~ ,~ PAGE ~ OF
<br />
|