|
„NAME •JCYYRUSI YRHT`n V41,1.
<br />;`',-IDDREw,h1Ne5..i,xc3 ~nuTII,
<br />,,,'1~410orP-ASr n.iNF~aT.
<br />1
<br />"' '' ENGL£IE:QDD
<br />.~` FAnLm T• .
<br />LDCAnDN ~ '~ '
<br />ATI?IS t1UHEIi II, I'~'I:1,~+'-
<br />Y ::,?. I. !. ". Nb~n..noc ,nu,ulWUl~u I,cVUnl UAlhl
<br />. ~ 7-15 17-I9
<br />r. T f! (. 1. T' PERMIT NUMBER D19CHMOF NUMeFR
<br />(' ~ 'f C' 1 5 `. MONITORING PERIOD
<br />YEAR MO DAY ~ YEAR MO DAV
<br />FROM '1 '! ;. TO ^'! `
<br />'- t-" '' }7 \ } }•, ~ !} '! /1QN1 11b231 /14761 I]6~71 I1B-191 /30-311
<br />., r ,! .. -~ I,rJ•; i` .I•~OMB.INOI}2040-0004
<br />(,; I1 ,, •+ ~ r 1, APProvel axP~f'ti 05-3198
<br />i - T'T NnT. L
<br />„F.Tnn
<br />NOTE: Reed ImtrueBom balm. eompletin8 thle form.
<br />PARAMETER !3 6/d Onlyl QUANTITY OR LOADING . !4 LYrd OnlYl QUANTITY OR CONCENTRATION ND, FAEOUENCY SAMPLE
<br />
<br />~ ~ 116631 54.6! 138-15 !4653 15L5I
<br />EX OF
<br />!31.17) MALY519 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rr7~a1 181-587 163701
<br />('ll SAMPLE ..
<br />~ ~ C•^,:;-1: is
<br />~ ~ ~ ~~ ( t?)
<br />~
<br />. ~ MEASUREMENT `-~ g ~
<br />~ / J O jL' X11' /1 ~_
<br />U04UU 1 U (1
<br />.. .:
<br />.PERMIT •s?~:, :'t:
<br />:. :•.I :r. :':er^ r i::: [: ~,. ~..
<br />... ': r~;•':_=,z .~,1.: «.: ~.} .! ,; •.
<br />I:F'PLUtII"f .;n~~;~ 1•±. r, •l• REQUIREMENT: :. ,: .l::;tr,:.l/!. ~~i.; -!•
<br />SOLIDS SETTLI;n/I I.'
<br />~
<br />~ SAMPLE
<br />,
<br />~ MEASUREMENT
<br />U S P U f` PERMIT.. • ., ,., ,;.....,.:
<br />,.~..~
<br />:: i:C'<~e r:eY 1,
<br />t:;..-
<br />~.: .: ~.. I: ..:-)Ir
<br />~^i^,.,'; r, ...:
<br />~~.: n,• ~,; .I,.
<br />..
<br />,/ ~,
<br />~<
<br />I,.
<br />:; F. T•, COt!::':KTS ~';1~I,n~,! REQUIREMENT. .. ~.~.:~~~...~::: ~:~: lr,. .,. ~: , "1 ~1 ~ 1,:1....x.,
<br />soI,IDS, `-ihTTI!'A"[.~
<br />' ~ SAMPLE :Crt^:::;: ,:-p;r::: r;
<br />~ r: •. r: •.. :.: NO,^N 1515
<br />mil
<br />Q Og
<br />4 ( ~q)
<br />t7
<br /> MEASUREMENT (
<br />~
<br />~ L /J1LI (~ 1% f ~I
<br />JUStlS 1 (1 '1 '.PERMIT: ~R.'.: cr: '•Cit rx r, r;: ; ~ .. r., pr\!.^• -
<br />'.`
<br />r +.»
<br />/ •
<br />J
<br />•
<br />F.F~''.j,UF:+I't 'ak7Cr- '1!L'I; REQUIREMENT. ,.. ,. .. 1''fhl ..r.: . n[.r.I":.:"::1 •+l~r t'~,~T"
<br />JIL AHD GHF'n:il
<br />' SAMPLE ~.'.•'.r ~. ^r~^ + ':irf•t:':
<br />~ _. ^
<br />(~/ ( ~ •))
<br />Q
<br />IJ
<br />n'1
<br />'
<br />ICT7DN EXTF-CqA'! N~'r; MEASUREMENT 7` n /~~
<br />7USSb L U. D PERMIT
<br />.~~ .... 'f, "' :r.:; ;a:. r, k:, .. .. `. 7q^T nT
<br />': P F I. Il E N'P !; ? ~ : ~ '; e } ' I • .REQUIREMENT - ..
<br />' t',, :.',,,.... , ,. ~ / ( ,• T
<br />f•'LO'a, I"I ~J!1 ~);:I" ., :, SAMPLE (
<br />, ~1 '•'~.t:..., ... ~: r, :. .::. ..
<br />4
<br />fNNU TR EaT"E.'IT "Ln'1'' MEASUREMENT L',~Z 3~, (' p34, ~p (~ .3rJ In1' 7::'
<br />iU05U 1 fl n PERMIT.
<br />:. ~.. ;}r.'E.'D~',^.
<br />
<br />~ ?trTI`1R 9.j; s?E,r: . .
<br />
<br />~ ': r-.,. `..i 1::vl~v .;
<br />`: F F L U F; K T G D ~ ~ :, V r. L'! ` REQUIREMENT ';1 ~ •- q ' ~~ ~ ~ ~ ~ ~ ~ ~ ~ .
<br />lIL AND I;kFAif SAMPLE •:~'`f.•- ( JII) ...... .. ~
<br />1
<br />•IIAL MEASUREMENT d O 3c) (!tu1~
<br />fib l :1. '1 :~ PERMIT.~~ 'iY 9.:' ~~ Y F:-a1 t><:...t.., :1 ...:v t:^ ~^^,.... ,r(: I,v ~~`: I:
<br />II•
<br />'LIIE'+T GP:1:,; 5'r,I :REaUIREMENT ~ +IS*
<br />'
<br />'TA°~
<br />I '!~_0 ~~
<br />. .
<br />.
<br />.
<br /> SAMPLE
<br /> MEASUREMENT
<br /> .. PERMIT
<br />< .. :... ...
<br />:: :: ~
<br />
<br />~ ...
<br />
<br />~~
<br /> REQUIREMENT ~: ~ ~ ~
<br />~ . ~~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ '
<br />NAMEJi1TLE PRINCIPAL EXECUTNE OFFICER I cFATI
<br />AM FA FV
<br />UNDEA FENNr OF l
<br />MIUM WIT7 TNF INFO Aw THAr I NAVE FEnsoNALLV EXAMINFO MD
<br />RMATOM eUlMITTEb HEREIN; AND eA5F0 ON ~ TELEPHONE DATE
<br /> MY INQUIRY OF THOSE IM DIVIDUALB IMMEDIAT0.Y RESPONSIBLE FOR i~
<br />7 '
<br />R~chal•d M1~IIIS OBTAINING THE INFORMATION , I BELIEVE THE SUBMITTED INFORMATION 19 ~
<br />~
<br />ry
<br /> TRUE, ACCURATE MD COM RETF. I /,M AWME iNAT THERE MF j
<br />, ~~„
<br />i hl
<br />a
<br />E
<br />i
<br />l
<br />t SIDNINDMT PFNALTIE9 FoR 9UBMImNO FA16E INFORMATION
<br />INtLwINO '
<br />'` n {}
<br />f
<br />an
<br />~er
<br />R
<br />r
<br />v
<br />ronmen . . ~ 7(1. P7Q~~712 S ~ I )
<br /> THE POSSIBILITY OF FINE MD I MPIIISOMMENT. SEE 18 U.s.C. 1 7007 MD 71 OIONATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED V.B.C. 1 1710. 01rWdrr/ YIN tlNro Iro1,Ih~ mYY YK41II /iNr ~ ro I IO,000
<br />rMamr/wnirYr/s+HwNWMtwwl4nNr,NarMlYroral
<br />OFFICER OR AUTRORQED AGENT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />L~UMMCr1I a F1rvY CArL/\nn I rvn yr nn 1 Ylv~n I,v,~a In.,vmc. ni nucnmmu nwsl
<br />Sk:TTLEAULE 57LI!1S fl"T!' i': anI'!`.'1 (L7~ 'I"1 1KLY Ir >L'1-TSr T'I-rn ^,:'•••TI, :-•'r•'~ T: r'rnT•rll~ ^,~•T 1, t,'
<br />r
<br />PG IR PrI FI III II (I ~V /.,T 1•, ,fir ai vi`tll: T°riT'~ ~ E o ~c_cCr rl \•.•n 1' ., ~ •.•1.1
<br />EPA Form 3320-1 108.961 PreviouB sditione msy be use IREPLACEB EPA FORM T-40 WNICN MAY NOT BE USED.1 „^ T ~ , I I , ,~ PAGE ~ OF
<br />r ..., 1, , _ 1 ,.
<br />
|