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PERMITTEE NAME/ADDRESS pwer6 ArWryN~./faveuolUD/p.rAjf}., ~. .,,,; <br />NAME, _pQYD$BgORY ,C.A.77--•jL ,COn QjY _ rr _ <br />ADDRESS HOADSYD~` MI>t61 H E S PO$r` LS,F .-'~_ <br />P.V. BOY 1+130 <br />eeLISA,Da co slsas <br />FAal.m <br />LOCATION <br />ATTNS JOHM ~. NC6AB, PBESIUE9i <br />I DISCHARGE NUMBEfl 1 <br />MONITORING PERIOD <br />YEAR MO DAY ~- YEAR MO DAY <br />FROM TO <br />!161/1 lZ1-131 111-151 116171 118-191 !30311 <br />(}pproved. <br />(stlEH YC) nYY,~vay LJ~ j__ _.1L._ <br />F - FIIIAL 1 ~~ ;! <br />PINOA <br />#~~+ AO DISCYlIRGB ... ~~~ I ~ ~I . <br />NOTE: Reed InetrueUona befor' eom0letin0 thin lorm. ~ Y, ~' <br />PARAMETER !3 Grd O1L(y/ QU~ <br />- NTITY OR.~OADING <br /> <br />..• !a Gtd,Ontyl ,QUANTITY OR CONCENTRATION <br />r ~" <br />$ <br />- <br />. - NQ <br /> <br />• RtEOUENCY <br />OF'. - <br />131-371 !7653 !5I-SII 3 154611 <br />I3BJ51 <br />7!6 EX ANALYSIS TYPE <br /> AVER(IGE.~ MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS let--sal l6s-691 l69-)Ol <br />N SAMPLE 491*### ',{>}###3 ~`9##01k ~ Ian <br /> MEASUREMENT <br />.i U4UO I O O PERMIT. '::~tii49134 .'~, .:.#~9np9plat4. ' p#; ~ p~j". .: ~' -.: 44914A>k 9';L:D":"-.".'."".: ~-'" .R b1("LI"~ p}S#T <br />FfLUENT GROSS VALU "REQUIREMENT ". `.. ': .";,;.,'" :": #4011 Tay. " <br />~iJLIUS, 'TOTAL SAMPLE #fi#fit# <br />~ 9t9itIIR4# 11104+# f, .~9~ <br />~U.iY ENDED ~ MEASUREMENT ~ <br />: <br />~ ~ _ <br />" i,S30 1 Q 0 "" . PERMIT 3##N9Fp"::°.: . <br />"".... .:... <br />E?yil`>rr~} <br />::.":.. " <br />" <br />14# ... <br />~0~t1~# <br />~~" :. - "' <br /> <br />,: <br />7~ <br />.: <br />~ b <br />~7fJ~R <br />k'FLUENT GROSS YALU :REQUIREMENT , .., 091R# _ ~ , ~ <br />O ID , LTTLEIBLE SAMPLE ###4fi# #44#'44 0100#>< ~ ( ~~'' , <br />" MEASUREMENT ~ ~ " <br />U ~4 S 1 0 O PERMIT" ". 3?k41110il :.:"': ::. #9nR+-g14. <br />" #0: :. ~# 410ir4 " "" RB £OI~'r.". .""~BIt~EOR ~'~'.. - ? ,MGEi/ " ~~'AB <br />FFLUENT GAOSS YALUE ,REQUIREMEN7 :" ; <br />~~ ., . <br />..": ;""" #9#P 3QD ~1 :.11~G #11Y 1.Y 14~: AL L' ::"" N'1' <br />L JN, OT L SAMPLE ##Ofi## #Ofi4## ##0A0# ~ 19' <br />(AS FE) MEASUREMENT <br /> <br />1045 1 0~ U <br />.: PERMIT <br />" ".###~1?7L-7!". " <br />:" ~#91.040# <br />040; <br />~ "~#0091#0 ~ <br />.. ~rS ::.... ~~ .~:~.0 -- .. <br />= ~~: <br />~~"ef ~ <br />;eae <br />FfLULrNT GROSS YjLUE REQUIREMENT 491fi# 3Q(3A .j"YG "G~'BlY .0'Y MG L '"" HQ'ATH "" <br />) L AND GREASE SAMPLE .:4#fifi# ###*fi# 0###ps ( ],g~ <br />" MEASUREMENT " <br />)3Sd2 1 D O PERMIT..: 4 >¢~I-01 ..: ".: ,fi$AtO1C9< 494 4#1fIRb1P .: '. RtE#'J`A.~".. :'.::: <br />~:Q ~#{TSII aAB <br />F PLU ENY GROSS YALUE :REQUIREAAENT' <br />~.. ~'" . . <br />Y, DUIT OA SAMPLE ~ ( 03) 010014 - ~#0[004 tt904#4 "" w `. <br />'HHU TKEAil7CMT F'LA NT MEASUREMENT ' <br />IUUSD 1 0 D .`PERMIT", A41PD$'T::,.. :".RB;?O.R~'. tr"*'+6t07C4 ~O#CI?'4..: ..::0?Rd#:ole R44 $B"1CLY :R$1AN <br /> <br />iFFLL'EhT GROSS YALUE <br />RknuIRENiENT" <br />30Dt.:.AtB: <br />:.$4iL~„; II Y. <br />6D :. <br />;: .;".: <br />. <br />I-46# <br /> <br />. . <br />r __ .. SAMPLE_ - - 1000. ~ 10*4#44- ".." _ _ /!41?O*d _ _ - _,_ _~~,~ _. .. _.. .. _ .. _4. ~~~ <br />ISSOLVED MEASUREMENT <br />0295 1 0 0 ":.:.. PERMIT 0 44":.:::? "'"''.:ic+R91iCA .IQI 4# r#!011F104K1 ..:;.. H.$F~~':":. :;:;`.H'6ii)0 T~ : •. ~ : ". '~'6.L7 iRAEI ' <br />:PF(.UENT CAOSS YALUE .REQUIREMENT .". '.;. .".:""."."':" 9## <br />NAMElTRIE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFO uw TNAT I NAVE PEflsorluLr ExAMINED AND <br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br />` 11 <br />~~ JYQ ~/ ~ 1~ MY INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOfl <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />I <br />RE TH <br />T TNERE ME <br />TE <br />M <br />` _ <br /> TRUE, ACCUMTE AND COMPLE <br />. <br />A <br />AWA <br />A <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATON <br />INCLUDING G n4 <br />/l <br /> <br />~" <br />a , / ~~ <br />/ ~ <br />/O/ <br />7 ~~ C,/ n <br />4 (~ 11 THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 19 U.S.C. 1 1001 AND ]] BIONATURE OF PpINCWAL E7EEDUTNE <br /> u.S.c. f t7ta. lFMlrw• liter awr mnmA am hcAw rn.Aw ro 7/0,000 AR A <br />~ <br />TYPED OR PRINTED <br />W er,nrrlnxAtrhwira.rwnr of errrwn smmtll. mis rra/ <br />OFFICER OR AUTHORIZED AGENT <br />CODE NUMBER YEAR MO DAY <br /> <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Re/erencs ell strschmenfs here/ <br />SETTLEABLE SOLIDS LIl1IT IPFLIES ONLY IF ~l0YH,24HH PHECIPITlTION BVENI IS CL AIR ED. PERMITTEE KAS <br />~UHpEH Ji' PROOF WHEN HE(~DESTING RELIEF FAOt7 SET'ILEARLE SOLIDS PAINAA2 LI!!ITATIOFS. <br />EPA Form 3320-1 108-961 Pravioue editiana mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) D 0 5 3 7 / 9 P C ~ Z 3-1 ZS 6 PAGE 1 OF <br />