|
PERMITTEE NAME/ADDRESS 9.eYV FrleryN.WLermen VDlpewq
<br />NAME TRAPPER AIti[R ,, L+<~.
<br />ADDRESSTRAPPFR "!I`.IF
<br />P.:). ~QX 1q7
<br />CRAIb
<br />"~ 81625
<br />FACILITY
<br />LOCATION
<br />ATTM: W. ;GROG': PFTER ~, PRES/>°9 *!GR
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATON ]Y4rEM //NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT lDAIRI y i V 7 n OMB No. 2040-0004
<br />2-161 _ 17-791
<br />"]0737.LT5 OO5 A (^;'Iq {( ~!~) Approval expires 05-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER O _ e T `! 4 I. M :)
<br />MONITORING PERIOD p^!yn N3 TO u!'S'" Pr.l^7,I~RD GOLCR
<br />YEAR M6 DAY YEAR MO DAY
<br />FROM TO ~. . r~` +t^ nT cCH4RGE ~~y~ ~##
<br />l26I1/ l22-131 IIt251 126-271 189.291 13x31/ NOTE: Reed Inetructlaru belon eompleiin0 this form.
<br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING !1 Ard OnlYl QUANTITY OR CONCENTRATION NO FpEOUENCV SAMPLE
<br /> !16531 lSL61/ 138-151 /1653 !51-61 E
<br />l32-37/ X ANALYSIS ~ TYPE
<br /> AVERAGE MAXIMVM UNITS MINIMUM AVERAGE MAXIMUM UNITS /61.69! 151-6'gl ( 701
<br /> SAMPLE #t.;c#:R #drS:'f't y.. ~,.#,... ( ) -!) .
<br /> MEASUREMENT .
<br />
<br />•0400 'I U D ~:~.~~PERMIT..~.'. .: ~.: ~:Ffi.. :~.. :.: :tF :. :a p:: .: Frtr
<br />a. ,.. ..M.~- $~F:' 4,R .~
<br />5: .T
<br />~ X
<br />cFFLUEk~ i;R;)SS VRLU . REQUIREMENT. ::.. ..~.:.:.:~:.:....:. ::.; ..
<br />~.. :..:. ~~ #.tOtF
<br />4X'. :.~r~::
<br />
<br />,. . ~ Y:E.rT'lITTMf~.; S'I
<br />>::
<br />'
<br />~r D~, :. .R SAMPLE •~ #Z :3 # O>Q 't, ( JS)
<br /> MEASUREMENT
<br />US4'i 1 D D ;^:<RERNIF.:!:.:;: ::< .: ..:.:...... ::.. .:.:.... 1r gce7r:: A:'k: O!TAI
<br />;:.•
<br />EFFLUP.AP FOSS VALtI. :REQ`UIeEMENT .::.:::.:.:::':::::::. :. .r:':.:..::..?.::.:,r >O~Ct ;::::. ..: .. V..:.~'.k~ .~sf.^,: ;al.~ITL"1• :)S7I. Mi./I, .. .: E::>..$ .,.,
<br />~.. ,..-~ :.
<br />"~ ,.-. A. SAMPLE x 43 r,# ## ;k":N $#f:l:t'~ ( 1^)
<br /> MEASUREMENT '
<br />
<br />J'1'J 1 D D ..PERMIT: :?:<za ~ ~...
<br />. . !): .:
<br />F:PFLJF.NT G~D55 /DLO .
<br />SEQURREMENT
<br />~.. ` °`''
<br />....:.......
<br />.
<br />:~
<br />..<..:.
<br />~
<br />.. ' , SAMPLE ~ ~
<br />,. #r... *# ... a.~ O .:.y: #::
<br />•R•'u rR:~Ar'7WNr P1,,N MEASUREMENT
<br />
<br />.0'151) 1 U 0
<br />~,, .. ...
<br />
<br />~
<br />RLT
<br />:~! ;
<br />
<br />°F1'LIII•;NT GROSS [ltLO
<br />;REQUIREMENT
<br />:~34D~A:~~:1.~;:.°~.
<br />~~.:)# .:x'~:.:1C.:~
<br />NGD
<br />:..~.. ~::.;:~~:~: `~: ~~:
<br />~.~. ~.'~. ~
<br />#;:#
<br />~ -:<
<br />.~~'::;~~;:: .
<br />~r.~~~ ~:;
<br />~'! 5 , I SAMPLE ## 'k# ~ ( -
<br />IS•S i)LV,r•, (7 MEASUREMENT .'
<br />
<br />
<br />E`hLUENT t,ROSS /RLU ;REQUIREMENT:; ~:~.,.:~..::::~:~~:'.~ :...::::::::.:•. :::;:..::::~-..::~~.;~<:~:.:::!.:.:? #RO :s:<~'=:;,;.,:.:.,.:.:,.,)••.~•~. :.<: .. .::.: .,, ,,., ..;..:...?: :,,,.~~:<>..~; :.:.::: ~:
<br />
<br />'+ SAMPLE. '
<br />l :i U 1 L MEASUREMENT
<br />
<br />4D66 1 O 0 :.:;PERMIT:.:.::' :. ...:..:::: '':.'::... ,~.: ES=1 ;:. 1'lt~....$;.:.':. , : _. :..#><tt:s.p..• IR#'' '~~8 X IS ti i.
<br />Ef'FLUENT GROSS IALU REQUIREMENT, .: x1C$.'!' 11RS:: NO=O
<br />... ##h':
<br />..,
<br />...... .. ~ „ :
<br />::; ~~
<br /> SAMPLE .
<br /> MEASUREMENT
<br /> ..:~ PERMIT::.~~. :~ .~ ... :::..... ..:.. :
<br />:
<br />~
<br />
<br />REQl11.RENIENT'
<br />~~. .... >,: .. ..
<br />.
<br />:..: .
<br />~::... ~::~::::
<br />
<br />•.
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF L
<br />MILIAfl WITH THE INFO AW THAT I NAVE PERSONALLY E%AMINED AND
<br />RMATION SUBMITTED HEREIN: AND BASED ON TELEPHONE DATE
<br />
<br />Gordon Peters MY INDUIRV OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON I] /J
<br />~(~. /
<br />/ D_flZ4-4yD1
<br />DD
<br />L
<br />Z7
<br />
<br />resident /General Manager TRUE, ACCl1MTE AND COM0.ETE. I AM AWARE THAT THERE N1E
<br />SIGNIFICANT PENKTIES FOR SUBMITTING FALSE INFORMATION
<br />INOLVDING
<br /> ,
<br />THE POSSIBILITY OF RNE ANO IMPNSONMENT. SEE to U.S.C. ! 1001 AND 3]
<br />U
<br />S
<br />C
<br />! 1]1e
<br />fMWtl„ I,IW N,~ mnm, In,
<br />i1cMN, r,w, I
<br />ro d/0
<br />000
<br />BIONATURE OF PIIINCNAL EXECUTRFE
<br />TYPED OR PRINTED .
<br />.
<br />.
<br />.
<br />Y
<br />p
<br />,
<br />rMamrrnwnilpdenlre a/Mrw„nem,nN„M6r,va! OFFICER OR AUTHORIZED AGENT ARA
<br />CODE NUMBER YEAR MO DAY
<br />It,
<br />~R
<br />COMMENT9AND EXPLANATION OF ANY VIOLATIONS lRelerenee e/1 sttechmenfs here/ -
<br />iE:'1'Lt:ll Sl. h: SDLIRS LT~TT °RT Hh: IIAiV?D FOR >10l fi, 24 HF PR ECID vp ~qr _ gcg q[,'P Fp•r. T^ T.T"?-r, ^'T ~ UHI7 F'R
<br />I.A•1.D, AND ALSO RURDF.tl OF PR70F RE~7IRENENTS UNDER L A.3. !)7L ti; ^r^ASv _ ~-ov T n~l~ln)~ "05
<br />t!CI~`IITORLNG - I.R.3. 30 Dl[ A[ER1GF. ZS HIGA6ST IEONTRL[ 1fPR1RR (EOATRC ppDTOn pa:Onngcr;_
<br />EPA Fwm 3320.7 108.951 Prslrioue editlone may bs u9ed. (REPLACES EPA FORM T-40 WNICN MAY NOT BE USEO.1 /1 {) q q ~ / 9 q n !1 'T 1 _ 1 r,) , PAGE ) Of
<br />
|