|
PERMITTEE NAME/ADDRESS QrY4 FsihryNs./Lxanen I/D15Fwq
<br />NAME THAY[}4P. '3[NI'7,, i*w•^_.
<br />ADDRESS TRAPPF.~ gIvF,
<br />P.J. R7+ 117
<br />l'N9i.; !'? 91.F~5
<br />FACILITY
<br />LOCATION
<br />A'lTN: W. GJRDad P>'7'RAG,. ?N8S/.P,11 ?IGR
<br />NATIONAL PoLLUTANT DISOHMOE ELMINA710N SYSFEM /INPDESI Form Approved.
<br />DISCHARGE MONRORING REPORT (DMRI >, T N 7 p OMB No. 2040-00041
<br />11-16 17-19/
<br />"79032115 n1R A ($•rqR yell ApprOVel expires 05-31-98
<br />PERMIT NUMBER DISCHARDE NUMBER c _ c..•A1 Hn.,^
<br />7'SCu~n;r rp 4!13i£ r11LCR
<br />MONITORING PERIOD ~ -
<br />VEAR MO ~ AY YEAR MO AY
<br />FROM TO ?CS N1 nTSC,RAR;° ~I t6S
<br />lzo-1N !u-z3i tzar-? r " r~5•~7r na-~9~ 13a3N NOTE: Read Instruttlons M1or eomPbtlnQ ihls form.
<br /> PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !1 Grd Ontyl QUANTITY OR CONCENTRATION N0, FREDDENDr SAMPLE
<br /> 116-531 (51-511 138-d51 16.53 5d-6/ EX '
<br /> 131-371 µ~ysS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161-e]1 !sJ[68) l69-)Ol
<br /> AR vH.. l1. SAMPLE 4~aaaa ( 9q) !kGlk '.t -.k :k ^'.,`.:t?t ,. ... .. .
<br /> ~ I :, U A L MEASUREMENT
<br /> 8LLU66 l U U ,; ;:PERMLT':'..: :'.LuS1R.#6. .. . :.::'..:R~~;~.8'T'::::
<br />„ , F.~=1 , ..:. ,~f~$'#'~' =rCG#v.'7C ~!e'.-#r«3e".'. s7G: ~SU:Ai
<br /> P.PFLU8M7 ;HOBS IALCI REQU,I(iENIENT .
<br />L~:51' ItRY::: NO=O '~T`'I' .
<br /> SAMPLE
<br /> MEASURE(Y~ENT ~~
<br /> . ...
<br />~ '
<br />:
<br />,
<br />
<br />'
<br /> J
<br />18EM
<br />T
<br />;AEQk
<br />EN r ::
<br />:~
<br />: ..
<br />:.:.
<br />'::
<br />,..
<br />,
<br />::., ,
<br /> ,
<br />.
<br />.
<br />.
<br />,. .
<br />. .....
<br /> SAMPLE
<br /> MEASUREMENT ./
<br />
<br /> :REQUIREMENT.
<br />,:
<br />~ '~::.'~~::..: ... .
<br /> ~ ~
<br /> 1 - SAMPLE r :
<br />~ "' K.
<br /> i~. ~~ MEASUREMENT / ~ ~
<br /> ~
<br />~ ,
<br /> r :'... PERMIT :'. ~ :.:... ~... ~~..: : .y .'.
<br /> :REQUIREIi1ENT. ::.'~: ~~.~... ~ ~ ~ .
<br /> SAMP E
<br /> MEASUH~MENT
<br /> :.
<br />..
<br />
<br />~, .._
<br />,.<,_-:
<br />~
<br />~
<br /> .:.. . .. ........ ..... ...
<br />,. ; .~ • ~:
<br />z . ..
<br /> SA P ~
<br />. -
<br />~.
<br />~
<br />~~,
<br />~
<br />,
<br />_ -
<br /> MEA5UR5MENT ~ '~ ,
<br />-
<br /> ~. .. .,... ~,<,. ~..,v ....
<br />.
<br /> ~~~~ ,.
<br /> SAMPLE
<br />' MEASUREMENT
<br />
<br />.. ..
<br />..
<br />:.
<br />
<br />: ~
<br />:
<br />
<br />'
<br />~
<br />.
<br />
<br />:REQULR~IENT':
<br />.~:.:':':'~ :::.:::: ~- ....:
<br />....... ... -:
<br />.. ..:. ~~.:. ..... .
<br />:. :.. .:.
<br />:
<br />..:'
<br />.: "
<br /> NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I HAVE PERSONALLY E%AMI NEO AND TELEPHONE DATE
<br /> AM FAMIUM WITH THE INF0 1U1ATION SUBMITTFD HEREIN; AND B ARED ON
<br /> MY INOUIRV OF TNOBE INDIVIDUALS IMMEDIATELY RESPONSIB LE fOR ~~
<br />~
<br /> I BELIEVE THE SUBMITTED INFORM
<br />OBTAINING THE INFORMATION ATON IB ~ /
<br /> W. Gordon Peters ,
<br />I AM AWARE THAT TNE
<br />D COMRETE
<br />'
<br />R
<br />RIL 9]U-g~/i-
<br />}4U1 ~U DI 27
<br /> TRUE, ACCIIMTE AN
<br />.
<br />IN
<br />SIGNIFlCANT PENALTIES FOIi SUBMITTING FALSE INFORMATION E
<br />E
<br />CLUDNiG
<br /> Preside~L /General Manager ,
<br />ND IMP
<br />E 18 U
<br />B
<br />C
<br />1 100
<br />E
<br />T
<br />S '
<br />I .
<br />.
<br />THE POSSIBIUTV Of FN
<br />A
<br />RISONMEN
<br />.
<br />.
<br />1
<br />E
<br />b
<br />W
<br />rM
<br />Y
<br />A
<br />A
<br />d AND 77
<br />F BIONATlM1E OF PRINCIPAL E7(ECUTNE
<br />1 r u
<br />r
<br />le
<br />r
<br />ws ro ro
<br />U.S.C. E t 71e. lPlrrWe
<br />r mem. re.Y
<br />.
<br />/0,000 A EA
<br />I TYPED OR PRINTED .ns er mA.hx.n irLwan.nr or Mrwrne~mA.~wsr..:/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/erence e!l st/schmen/s hare!
<br />i TS5 F, 'PnTAL i4UFj Li+IT` '[LL R~' YAIIF.D, AND SfT'LPARLr'. SOLTD~ '.T'T•P lPDLT'^ ^'+ <_1~,Yp
<br />-.11:~ uRP
<br />('TP PVu"%T-
<br />F
<br />.
<br />F' SEE HIJFIitiN JP P3ODF RF.;~UiltF''P.NTS ONDER I. !1. 3. ^DS NONIT'1P.I'YC - T.1?.'•. '~i*., °" ., '+"I: - -^ I,x~.l.(D).
<br />DAI AV "CAGE 5 RIGN EST K>M*HL.7 AT R.BA+A DORiNG PRRT!TD 9P.P7Prc~,
<br />EPA Form 3320.1 108-961 Pravloue edluons may be used. IREPlACE9 EPA FORM T30 WHICH MAY NOT BE USED.I ,i ,~ t ., t / ,a ~ ~ I, ~ T 1 ,~ ~ ,., PAGE ?OFZ
<br />
|