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l ~,aq : . e _ ~ .. u. ')..~_. Na./la~u VD~ PERMITTEE NAME/ADDRES$p b FrW i ~ .r i n NAME RERR ~ORL CD'IPAgY ., . ADDRESS HARK MIKE P.o. BDx 773u,7 SiEA!!&OAT SPA[`:' ~ ~~ 9J177 FACILITY LOCATIDIJAALDer ~o aDiiD --'~i'1'h: GEOk^e ~' !. f'A *TE-i 5.7 .Y. .aINP. Y~%i. DISCHARGE NUMBEII MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM Y' U J TO ~' Lt !1 /7677/ /11-73/ 1T4151 /ZbZ7l 12H-791 /34311 '- _. :.:w-; ~ Foim ~APProved. ~'eq" -POND C/2RIB TO CAA~BJ~°A ~O~iLCA (5 U R R N W) Approval atr~l~e~ O 31-98 t' - FINAL 1L CINOR u:x No DlscWa~fGE I.~_I =''~` NOTE: Reed Instruetiam before eompletinp 1hN form. PARAMETER l3 Grd Onlyl QUANTITY OR LOADING !I Grd OnNI QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE lab531 /5x611 !3B-~51 I<6531 l5i6/1 EX OF TYPE l37-371 ANALrss AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs7-sal 164-6g1 169-701 r':1 ~ SAMPLE #C 33R;~ 3.^•J'1 R'7. ;k ;:C ;F:: ( 12) MEASUREMENT - ~'J~LJU 1 U L' PERMIT ~ #~P91sR Ra~F4.~ao ~ ~ #~1R S.S "A'u'+« ~' 9.0 ~.~ Ef,RLY .N'`IY7 ~:FFLUcB° ;;ROSS YALUE ~REQUIREMENT. ~ .: ~ #4RR tL>i riU ~ .'h 'Y R831~~. :: ~+Li U.iF .,ETTLE A3 LE SAMPLE f:RRRRR R':RRRO R/JR#i: +"% #73 .-# ( ~j) MEASUREMENT JUSU S 1 U U .:.~PERNII7- ~ ~ Ft~A~R6!AR~ ~. ~ ~ ~3RaR~~01:G~.:. CrkJ ~ .R~OdI:iY~tTiF ~ ~ Jfstk6 V,t 4...$ . ~~. .. ~~.C )ICE/ ; HA P ~~~„ LFFLJcnI :t>>SS YALUE :REQUIREMENT 49?•R DA / Li N ULL ANU 04t.AS° SAMPLE rsR7'~:? #'dk?p? #:rK#Ar;- ;t:}# #R ( I9) MEASUREMENT )l~ti2 1 0 U QfRM1T crRRa~l.a.:, : :,,.:RR#R#-~ ##G R#;72.tC kiXR4 # LU ( (INTIN ~gA3 tFFLUENT GRO55 YAL'JF REQUIREMENT L~+~OI ~ DAILY MG/ is °.D• 'LJa, Id COND'JII OR SAMPLE ( D,j) Gt?#~Ix #o,^^• ~~ O#~#;'~ 1:ikU THCAT IFERT PLA.7T MEASUREMENT iJuSU 1 D 0 PERMIT: ~TiONA4 P-EPO&T rG~RR# ~#:s~ a. #C~tr~~t, .. :fir:- 1 iiCF.J .NSfAH :FrLJSMT D iS VAL'1F ;R REQUIREMENT: ~~ ~GDA AY : DAILY t4x I1GD ~ #•' :#% M:1NTH - . . ~~::.. .. , . ~ • i i:. AND .;h EASt; SAMPLE'.. t•?`G.-~? ( '17) '}:-#r.V;= .-;rC 4rt r,. r„-#;I t.:k V I ;JAL MEASUREMENT ,a;;~,e 1 D U PERMIT : wx:<Ray. REPORT l YS=i aR~Raa Rear C ;rua~i~.~~ :~e:v c .H.GE/ LSUAL :.f t'LUENT SROSS VAL!I.': . REQUIREMENT ~ .~ ;IRST !s.A~=~ NO=D r ~ - ~ RF4#. 1'SO6TR SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME7TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF AM FAMIUAA MATH TXE INFO lAW THAT I HAVE PERSONALLY E%AMINED AND RMATION SUBMITTED HEREIN; AND BARED ON _~ TELEPHONE DATE v.-_ RS h A A M Mr INQVIRr OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTNNING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION IS / ~ ~ ~ Q ar . I1T190T1 ~l P id t , SIGNIFICANT PENALTIES FOR SUBMITTING FALSE IFIERORMATEON TINCIUDMG 1 -- ~' /`~" g~0 72 -421 nn I' ae res en , 3 W QZ laF THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 18 U.S.C. 1 1001 AND 3J BIONATURE OF PRINCIPAL E7EECUTIVE U.S.C. 1 13 t e. IFMMM. utlr, dw,..6Nh. mrY Ncald~ lNr. R. ro F 10,00° r TYPED OR PRINTED ens>muMN.n inpriavrw,nr W Nnvrn snNndv rM 6 Yral OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAV COMMENTS AND EXPLANATION OF wnr vwLw I wrvs llrnersnce sn emcnmanrs Here/ ;ETTLEAHLE SOLIDS LI.".LI dAIYEG FOP LU-YN~ 2U-H4 PHF.CIP I?YENL' :.u DJ~;;I C~ DUkDF.N OF PPO~; P.~:IIINE'PEyT-' IN ?!L.Rf i. H. 1. D, C. 6. ;IORMYATE4 "ANA~EtlF.NT PLAN DUE 1-1-V3. , EPA Form 3320-1 108.951 Previous editions may bs ueed. /REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) 0 J S 0 / 9 7 0 d 19 - i 2 5 u PAGE 1 OF 1