Laserfiche WebLink
1 <br />1 <br />PERMITTEE NAME/ADDRESS p«bM FsNry N.w/focaua• dD1d.•.n0 <br />NAME NQai [; I--. .. J.i ~. .. i, ,. .. <br />L L .'. I "." <br />ADDRESS H 0 ~ I r.. '~ .l . '1 I ; ]. <br />PAu;I6 is-~ C1U2`1 <br />FACILITY )iU~i:, ,:J;~:.-: ~, LI ILT ;J <br />LOCATION <br /> <br />NATIO DISCHARGE MONITDORIN6 HnEGPORT ~ Mq PDESI <br />11-15) 17-791 <br />^ P-RMT N BER OISCN GE MBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM D TO .- - ' <br />!161/1 l11-131 /11.151 !16171 l18-191 1343/1 <br />Form Approved. <br />OTMB No. 2040-0004 ~ <br />P 7 i D C D S C'i r; +r) F,rp~rovel ezpne5 0~~1?g8 <br />(SOi3R IJC) 1?345 l> <br />F - 'r'I':AL ~ <br />.,1\(i ~{ <br />.. I N~ ~1ISCd ~nLC J'_1 ., 1., <br />~NOTE:~ Flee inelNCtfOfN film eempletlnp t~lie lorm. <br />sl <br />~~ <br />IC <br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !1 Grd OnlYl QUANTITY OR CONCENTRATION NQ FREOVENCY SAMPLE <br /> !46531 !5461 l38-151 !16531 l51-811 EX <br />l31-371 MkYyS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is1-ssi l51-5B1 169-701 <br />~)iy ANU :;Zta'i? SAMPLE ~ ,. ,.:.CC ( 94) .}.t :. ;: if :~ ,. :::;c ,r:;: ,;::F <br />' <br /> MEASUREMENT <br />Y : ~ u A L <br />c•.JL6 1 0 U PERMIT <br />~ `.:OfiCPRC <br />~ iiEPDR:I ES=1 R.OfsYS:~? :'it;n# •:.. :.:(a~tlwf< :x:::~ FEKLY VE.SU~ <br />, <br />- REQUIREMEN7 ~ <br />, <br />S r- Ly -, <br /> SAMPLE <br /> MEASUREMENT ~: <br />~ ~ - ~ ' <br /> "~~:. :PERMIT '::~"~: ~ ~. .' :. <br />: <br />~ ~ ..:: <br />.. .. .. . <br /> ~~R <br />EQUIREMENT <br />: ... ~ ) .. <br /> ~ <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> "'~ PERMIT ' <br /> ~REQUIREMEFIT <br /> SAMPLE <br /> MEASUREMENT <br /> . PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT + <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> flEQUIREMENT~: ~ . <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDFR PENALTY OF LAW TNAT I HAVE PERSONALLY E%AMINED MD <br />AM fAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> <br />1'' <br />F MV INOVIRV OF THOSE INDIVIOUAL9 IMMEDIATELY RESPONSIBLE FOR - <br />r <br />~ OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS J <br /> TRUE. ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIONIRCMi PENALTIES fOR SUBMITTIND FALSE INFORMATION <br />INCLUDING <br />'' - ' <br /> . , <br />f THE POSSIBILITY OF RNE MD IMPRISONMENT. BEE 10 U.S.C. f 1001 MD 3] BIONATUIIE OF PIIINCIPAL EXECUTNE ~ Y) ' (- !~' <br /> U.S.C. f I]lY. IMPS, lnlr IM.r ,uwna nrY McAN~ 5rw. rq ro 510,000 <br />11PED OR PRINTED w«mui+wn MpicvF•wltW al..NlemmMaw6Y.N'~1 OFFICER OR AUTHORI2E0 AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANAIIDN VF ANY vIVLA 1IUn3 INI/IrenC1 M/ errsenmsn is natal <br />;t.1':Lt;A:SLr: SJLICS LI9[: APP 6IEi UNL'f IF' C= LJ-YP, 2LL-Ild P!+L,;LC ~7r.rlf i[' '.L~i"'':f. IF CLP.I~ '.`~ 5Pf'i;~v G <br />Y' .1Cf1A f53 E IBJN LI'!IPS GILL 4~T ii' APPLI3G "J RF:?.~;j C•:) .1 c!La LIh ct: caiS -ScE. [.'..11, ~.~ S AH;, I. r'.1:', r;, <br />!. ~ <br />L j <br />EPA F-w 9~1'11~108L9TaP P4L6i11J- dd'nioml'~T{ey GAIIkNd. u ~v ^_ 1 ~ 1 -IREPIACFS EPA FORM T40 WHICH MAY NOT BE USED.1 PAGE OF <br />