|
PERMITTEE NAME/ADDRESS pnrLf. Fxwry NawJlx.rrm I/DlQinna
<br />NAME !] J 6 L i'. .. r. _. - 'f l , :.. -iii t~
<br />ADDRESS tl u : L r. '~ .1 . ! + -
<br />FACILITY
<br />LocnnoN
<br />NATIONAL POLLUTMT DISCNMDE ELIMINATON SYSTEM INPDESI
<br />DISCNARGE MONRORINO REPORT IDMRI
<br />12-161 17-191
<br />. ~
<br />- PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM .• - nll ~~ TO , „ '•
<br />on-]fl tl1-031 tlL]51 /I5-171 /]B-]9l !36311
<br />Form Approved.
<br />OPIIB No. 040-11004
<br />F' i) H D C C S C N :: T I °,eiparovel expires 05~ i98
<br />c - F'I ~~A1.
<br />P15~.
<br />•~NOTE:~Rss~fns(ruc~laro bstor~ eom~lsting this form.
<br />PARAMETER l3 Ord Onlyl QUANTITY OR LOADING /s Ord Onlyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br /> 116-53 !54511 1385/ 1~6-531 15461 EX TYPE
<br />131-37/ µµY616
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is]-ssl /54681 169-701
<br />rri SAMPLE :~7,`•~:G a:r :: ?:: ~' ,., ( Ii)
<br /> MEASUREMENT
<br />'J ";'IJJ 1 U rT PERMIT
<br />~ at C;n aCtF G441t'stGG :c:/rF $.~ ~-~~"''•`' 'i ~.U -~'Ei: ). `:' I~K:i Ii'
<br />. REQUIREMENT ~ ~
<br />,, _ . y,, . , ~ <.
<br />-
<br />uj, ;i,rgL SAMPLE
<br />axaGaa
<br />aauaa::
<br />.zaxc+~,;-
<br />t
<br />( 19)
<br /> MEASUREMENT
<br /> ~
<br />v:)1~U 1 J D ::':.:'PERMIT ,.
<br />•....... :.
<br />^>Y ~9FG pCt~Cc ':: :datf GR:
<br />
<br />~ G=St' aa.uuaa ~ ~35. 7~0 ~ ~ - "1C?-/ ;ir 1tR
<br /> REQUI
<br />REME
<br />NT :. ...
<br />~~.: .~ .
<br />'
<br />~~
<br />' .
<br />.:.. L. , L ~
<br />I' r .
<br />.
<br />..
<br />....:: :. :
<br />:
<br />. :. ,yam r
<br />.~JLiJS, SETfLP;ANLf . SAMPLE .;: ,,,.::; G{:GF~::: iic;:C.: ( vc)
<br />~'
<br /> MEASUREMENT ~
<br />.~~)5~i ~ I U U ~~~ P ~((S~IT .::e r,:Gana . ,-, G;e .~;: .. G;Ir#~±: itG F" 1 ".' 0.5 'N.' / ;~f~:El
<br /> REQU~l~MENT -
<br />~
<br />~~ ,:.t , «
<br />.~ r
<br />~
<br /> SAMPLE :: -~ ., a :; ~ ~ f:
<br /> MEASUREMENT
<br />AS P'~~'
<br />(
<br />.J1 ~!'1 1 U D ~ PERMIT is .,a a::::
<br />~~ ,., ., a`3 ~kaPt: ~.~ /:.17 - "1C%~ i3~L~
<br /> REQUIREMENT r
<br />I I, f : r- n r
<br />^ "• r
<br />)TL AVU vfl?ASF SAMPLE ;r ;e ar: :: :' .. .... ~Y:=:: i~ _
<br />~Y (
<br />I T)
<br /> MEASUREMENT
<br />:}.1':Z 1 U D PERMIT :
<br />r:°AagtSr Grc.::;r;t:: ::.. aUa4rsr ::Yt~° >x 14 ~ ':'J~:pI'r :~~AU
<br /> REQUIREMENT fi '
<br />- I ~- ; I 1 , ~ ,,: ., F
<br />;'' Jn, I:i i:UNUJIT - ]
<br />( ~ t
<br />~ 1 :: ~~~~~ ~~~ GS~ •~ f ;~rp~G~
<br /> MEASUREMENT
<br />~;l TlecKr~•::aT >LA : I
<br />_JJJ.) 1 U J PERMIT pDRT 'iEF'UdT aGi:C. .:ai~v G >::~:.`•4: :: r:.
<br />~ "r
<br />L
<br />+ .'.>;'AV
<br />°r U ~ p . ~ 7 L REQUIREMENT ~ r - ~ .Y.,:_... .
<br />.
<br />
<br />. Lii75, PUPAL SAMPLE ~ ;:G t'.:: `:
<br />r
<br />? ;::3 ;: :: ^: ~: ~,. ( +r')
<br /> MEASUREMENT '
<br />: ~i J L V G U
<br />..
<br />~l ~~.li`.I 1 U. C PERMIT •t: '::`-~y;c%f .-^.:at: tr4 ~ "°:~^ at=-sGr. dLP~ T t)PTIiI:iAL ' : P'+LY ~1Ab
<br />': 'r :'L'J6AP u.`iU55 VA J"t REQUIREMENT. ':~j r,: ~:;:a ~ p t v,
<br />.~
<br />N
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFlCER I cERn
<br />AM F FY NDER PENALTY OF
<br />MI M WITH iNE INFO LAW THAT 1 HAVE PERSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br />' A
<br />MY INO IrY OF THOSE INDINDUALS IMM WIATELY RESPONSIBLE FOR '
<br /> OBTNNIN THE INFORMAn ON, I BELIEVE THE SUBMITTED INFORMATION IS
<br /> TRUE, ACC~~CCUMTE AND COMPLETE. I AM AWME THAT THERE ME
<br />INCLUDING
<br />TTING fN
<br />SE INFORMATION
<br /> ,
<br />SIONIFICAf1T PENALTIES FOR SUBMI
<br />.
<br /> THE PoSSII@BILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD 77 g1pNATURE OF
<br />PRINCIPAL EXECIfffVE
<br /> U.S.C. 1 T.TtY. IPArrM.. tnOY fMM mNMA nvr tic'M,IA lmA ~ ro s IO,OOD .
<br />TYPED Ott PRINTED ..agnrhYnr.n irwimw.nr or Mrwwn a.Nnlm.xs y.NA/ OFFICER OR AUI'MORRED AGENT CODE NUMBER YEAR MO DAY
<br />~>,~;,
<br />~?,
<br />COMMENTS AND EXPLANATION OF ANY VIOLA I I V N({{{{s l7rerersncs sn srracnmsnrs oars!
<br />5~.::i.i:AFfLI' i~LI„5 LL"1: APP4~5`; OvLY IF <= IJ-Y',
<br />1,r uY +~i:U, ISi ° IP.)r' LI:: i.fi H L1. VUf 9E APPLIED TO
<br />v
<br />t
<br />~e-4r PF.L,.LI ..V c:+L "'LA7Y._D. iP CL4T' I r',."':'F. c•...
<br />3I'Pf/P^!' fr.t..nL..:i:~nN:S -SF:1 I.i.lA, ~`; i 1V~ F.1!, ?~.
<br />nOt Tse OSt0.l rave or
<br />
|