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PERMITTEE NAMEIADDRE356.rAm farlArylJw~[oranw yDdirn0 <br />NAME iYfNTYNILE COA1 CC <br />ADDRESS 29515 R0U7T COUNTZ AOAO / 27 <br />CAR CHEER CC 8047 <br />TiIEMTIHI LE CCAL CO <br />LOCATON <br /> <br />x• r s r <br />PARAMETER I3 GN Onryl <br />137-371 /4653 <br /> <br /> AVERAGE <br />:EFFECT STATRE 7 DAf SAMPLE Yv>r#, <br />CbA CERICCAPRNIA MEASUREMENT <br />TCP3E ~ C 2 <br />_ ~':<syPEflMIsTF';~ <br />$ ,;;;;` ;iRiFlbt <br />~' <br /> g <br />R <br />EnUIREINENT <br />: ~";::" ~... <br />`.:~,.;:;:.~ <br />5 . . 5 F . <br />.., <br />' <br />:...: ,wx:: ~;.;,.s:,l.,:: ~. . .. . <br />.. .... . <br />r ., .., ; ~ <br />3EPFECT STATAE 7C,19 SAMPLE tv#### #~ <br />CHA PIrEEH-LES MEASUREMENT <br />......:z :.r:~..: •. , .........:.:: <br />T C f 6 C S 0 2 ~••PEaMIr •' yT#,~#~ >#,~#~; , ,~: <br />• • ... <br />~REIIUIREME.NT: '- ~.... .. ,. .. <br />SAMPLE <br />MEASUREMENT <br />:.:.:...:.PERMIT..: ":.;'.: ..; . ..: <br />RECILIIREM.EN7::...' ~:.~;":~ .:.'. ..:: .. ... <br />rcmm~ ~. <br />1GIREINENT~ '"~~ <br />SAMPLE <br />LSUREMENT <br />"PERMI7~::~::: ".:.::: <br />... :. <br />T <br />17µT DISCHMGE ELIMINATION SYSTEM (NPDE31 Fonn Approved. <br />aRGE MONITORING REPORT (OMR1 <br />'-161 n7-1sr <br />CN AOMIC WE7 a o I0E~4~0~J <br />T~~~ <br />TESTI ~~ <br />0 37-98 <br />` ~ (SUEIR NW) roveie r ~ <br />LJ4 <br />MBER ISCMMGE NUMBER F- F I N A L <br />MO i I G PE IOD r.I NOR <br />MO DAY ~ YEAR MO DAY _ <br />10 0 {4~. 0 2 i ##~ No Dlsc xARCe ~ ~ #~~ <br />-131 174751 6171 11B-191 !36311 - NOSE: Reed Inetruetiarfe baton eolRpleTlnp this form. <br /> N lYI QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> -151 146-53 5461 <br />EX of <br />TYPE <br />ITS ~ IMUM AVERAGE MAXIMUM UNITS lei.6a1 ANALYSIS <br />!64681 !6&701 <br /> <br /> <br />G-^• ,.:F <br />~_:~"~`'. %'s: : ....... .:.... <br />~.:)~?~.`..IA~:. '1.IL,~p..~: <br />'(:; <br />zic>:i:' ~,)t~.'~:~fi?~~a'. <br />HR- .,:.... <br />diF`. ...:: <br />~:~'.,~..~~i~' <br />~.~~~~::'<~:: <br /> <br /> o X42 GkAtS <br /> <br /> <br /><_~ <br />. .. .:.::. .....H, ... 5..:.: :: xE;,:4os:::;: .. .:... .. .: <br /> <br />~REQ[lIREMENT., ... .... . ~. ~ ~~: ~ .~'<::::: ;~~, ~~ .. <br />... .. .. ,.. .. 4..::: ,:.. ; . <br />SAMPLE '~ <br />MEASUREMENT <br />,.. <br />;.:: <br />:.,... p..::IT.:.:....::: <br />;: ; :.:. <br />; <br />.,:: <br />r EQ .IREIJIEf~`:L:~ ::::':>..:.::;" :r:r;:::.....;::~: ..:: . , ~:.. .. <br />~.... <br />. ..:r::,:,... ,.. ... .:~ :.. ~ ~:.. <br />.:, <br />NAME/TITLE P 1 G EXEGUTIV FICER 1 CERTIFY UNDER PENAL7y pF lAW THAT I HAVE PERSONALLY EXAMINED MID TEL DATE <br />AM FAMI}IM N1TN TMEINF"ORMATION SUBMITTED EREIN: AND BASED ON <br /> <br />Richard Mi)Is MY INO IRY OF THOSE INDINOVN.S IMMEDIATELY RESPONSIB <br />OBTNNINb THE INFDRMATON, 1 BELIEVE THE SUBMITTED INFORMA LE FOR <br />TION IS / ~~J - <br /> <br />Environmental hlana <br />er TRUE, ACCUMTE MID COMPLETE. I AM AWARE THAT THE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INC RE ME <br />IWINb <br />~ <br />J7O A7O-Jr ~2 <br />. <br />9 , <br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE to U.S.C. ! 1001 <br />AND 3] / ( ~~ <br /> u.S.G. f t]1e. IANWOY. Inar PIFw mnmr. InrY Ylcyy. 6rw. uP ro SI0,000 BIGMATURE OF PIIINCWAL EXECUTIVE <br /> <br />TYPED OR PRINTED <br />W or nrrirlun hWNRnrltWbe.«n enroneL rq 6 r.n+.1 <br />OFFICER OR AUTHORIZED AGENT <br />CODE R/BER <br />NU YEAR ,MO DAY <br />:OMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referenee sll stfschmenrs here) <br />SEP I.A.2 E 5 POR DETAILS OP TEST PROCEDURE. RHPORT LOYESI X FFFLUENT AT WxICH STATZSTICALLT SIG NIf' <br />CIFF EE7YEEN TEST 6 CONTROL N-S GRSEA4ED USING TEST COCK "S". <br />• IWC=21~. ATTACH CHRONIC TO)<ICITT TEST <br />orm 20- _ Pf v7ow itiom ey Nsd. _ O M 740 WHICH~IIAY NOT BE USED.) 00015 <br />:., <br />4A'~~ ~ <br />. <br />97 Og 0 <br />~ ~F <br /> . <br />• ./ 3-12 21 - <br />~ ~~ ~ <br /> <br />