<br />P[RMITT!! NAMEIADDw[e3 (JRC1Rdf
<br />Facility NamElLocafbn if diJJnenf/
<br />woow[nT~,'ILAC'~?-:-r-?~'~'1'tc12#1'`:.~.~=!=-C>~-Hf-pP.~p---
<br />___z"~~Ti--.-40ra~-n~ .D~+'k~-~F.~~-s-aa=~_
<br />-ACI LITY_
<br />LOCATION
<br />NATIONrrL FOLLVTn MT DISCMAq GE ELIM INATIO IYSTEM (NPDE51
<br />DISCHARGE MONITORING REPOT lOMRI
<br />1 /b ' 1719
<br />ir~OSD r
<br />~•~'. ~
<br />PERMIT NUM RlR DrscNwwcE NVMeEn
<br />MONITORING PERIOD
<br />YEA(~R MO DAY YEA1R~) MO OA]Y!,
<br />FROM DA 4 0 TO IJ J Ut JTi
<br />/70111 /1Llll QI.IU l76~17/ /78291 /30.71/
<br />:; I h G h Form Approved. 7'
<br />(5 U ~ fi .+C ~OMBENo; 20Q0-0004.
<br />i' - F Z N A Approval expires 6-30-91;
<br />I.t;;:, i 'IO H0. 7HOMP30N F.IYcn ~•
<br />~u:x G DZSCHARGF ~)GC~ ~~~
<br />NOTE: Rasd Instruetlons bsiore ebm letinp this form.
<br />TTU• TTY GT/1V CG
<br /> (J Card Only) QUANTITY OR LOADING rd Only) OU ALITY OR CONCENTRATION FR EOUErvcr
<br />B
<br />E
<br />PARAMETER (16-J3) (3161) (38~J) (16.53) 13161) NO'
<br />EX of TYPE
<br />•-
<br />(32-37) Arv ALrsls
<br /> AVERAGE MAXIMUM UNIT MINIMUM AVERAGE MA%IMUM UNITS 6763) (6168) (69.7//)
<br />OIL ANG GREASE 6AMPLE :}(:yY,)>;rk / 40960~t (r'7 fp (b:kQ Tf iY Ol it tl4
<br /> MEASUREMENT
<br />YISUAL
<br />
<br />
<br />b4Uti6 i 0 G _
<br />
<br />- . ~a
<br />~ PERMIT'
<br />s<
<br />;<`., l~
<br />s•. S~'
<br />~'_a`
<br />
<br />E5=1
<br />
<br />®°
<br />`
<br />4
<br />'~'.-~'.: b..ae.~_e^~e
<br />l?~1~?±!I'
<br />'g
<br />s~+la~
<br />Ja- A• .tY~
<br />:a
<br />D9R~i~R
<br />~?:r~4+'
<br />
<br />rotl+~r
<br />gna„
<br />F°~e~
<br />Ile'
<br />
<br />~
<br />4~ a}~
<br />
<br />~
<br /> gequIREN ENT'
<br />e
<br />' ?
<br />< <
<br />,
<br />< a
<br />^
<br />'°
<br />e ,
<br />^
<br />"
<br />x" r_~;
<br />~ ~ + ..^
<br /><:io«,.,
<br />r c vi ~_ +/a ~ p^a
<br />a>a
<br />r
<br />.Na=
<br />,- .a
<br />r .v r.r k~~.ew , ~.r
<br /> SAMPLE
<br /> M EABUREMENT
<br /> 'PERMIT
<br />•,~.
<br />%s`: %% affi
<br />~>a>°i
<br />$
<br />!°'"x~.a
<br />s iP
<br />~ x'+J~,, :x'
<br />a ':9^N°^4~>k~ tix"ae'a+
<br />4g g ~
<br />xa^saLr t,.<'an ~"
<br />e ~ oc Vaz
<br />~~~~~
<br />'
<br /> .
<br />~^RlOVIREy,HNT~
<br />s
<br />y ~
<br />`~^;:~ a s';
<br />•
<br />
<br />p
<br />,.
<br />
<br />e
<br />,« .P
<br />a
<br />..,'e
<br />x ° .' ,
<br />
<br />
<br />
<br />n
<br />j+vg:
<br />°
<br />'.~
<br />
<br />
<br />
<br />
<br />
<br />
<br />•
<br />~ 'sB<''°.",e< .
<br />,x Y
<br />~6~
<br />
<br />
<br />
<br />1:
<br />"<e. e~ .rn A„ uG .a
<br />~„i-
<br />< +
<br />as°
<br />s°
<br />Z
<br />,t )
<br /> e ,
<br />.,
<br />^ , ..
<br />J
<br />..c... ,
<br />x.. q
<br />. g .
<br />,
<br />,~
<br /> RAMPLE
<br /> MEABUREMENT
<br /> ~
<br />
<br />" `tlPERMIT
<br />ag i3
<br />>
<br />«
<br /><s ~4
<br />Po
<br />d)Y«am
<br />le a'~wp<+e i~'n°
<br />+'." g„
<br />4sd'~® g~
<br />'aRa i°,r^.. z~°~•b~II q y,
<br />`ab~&aed<'
<br />'
<br /> ~RlOUIREM ENT 0 ,w
<br />~
<br />bp }}M`''x
<br />~ a
<br />e
<br />~ ;rd<'°cxa"°a;
<br />"~0
<br />` ??yy.~
<br />° ~~~~vv I~
<br />`
<br />"
<br />,'
<br />~
<br />" s
<br />'<`~
<br />~°<
<br />v "
<br />'
<br /> ' a.,'. r s~P
<br />e_
<br />, .¢
<br />°ld~,tgs _° .
<br />gx ic$,9 °.~SS°.".;ce
<br />: ,~
<br />w' .e m,.
<br />^
<br />s
<br />fA r
<br />x' «;
<br />a
<br />r
<br /> RAMPLE
<br /> MEABUREMENT
<br /> ,~'~ tP[R111?p °'
<br />I
<br />M °e,^; . a, <d° # ''t ',e+.s <.. .'•I:
<br />,
<br />, ;«' sx r;
<br />~e `n` a%
<br />at'A t~ e t ¢ e¢
<br />A
<br />xe ~+9 Y~ q.,
<br />~:}a~igAt>£°ifr°': ,t vs
<br />~
<br />~ n f~ ~*~y
<br />c~tl
<br />~ a
<br />~81,°~Y%u
<br /> :R
<br />Ex T•
<br />EQUIRE q ^ (
<br />.A 's a,
<br />n
<br /> 9AMPLE
<br /> MEABUREMENT
<br /> ¢ tlc
<br />'°.PERMIT. c w
<br />
<br />-
<br />e
<br />„
<br />p c„f:,
<br />r °.
<br />.i. =.'2
<br />^
<br />p <^ n)~ ..g
<br />c_ `.s ;,9r3'
<br />e
<br />;""i"° 0yp.
<br />i,+,
<br />,"p
<br />~-
<br />V ~ p Vr Leg
<br />~' .~.. #^..«
<br />u
<br />ra
<br />S
<br />e
<br />+~ ~
<br />
<br />' :~r...m
<br />4{d '# M'6Y ti
<br />. ~.: ~a.~':
<br />"
<br />°"
<br />'
<br /> .RHQUIRElA ENT ,
<br />'
<br />Y
<br />~
<br />a
<br />~
<br />T aa~
<br />%
<br />x A .
<br />eY,a
<br />YY
<br />Po ~„
<br />¢
<br />~
<br />x
<br /># e •y,,,g,
<br />~
<br />R i•$
<br />,
<br />iA
<br />r#$~~
<br />ffi
<br /> .: ~... ~ ;~ .S $y.
<br />a g
<br />& e
<br />S
<br />m ~•jb
<br />0 <
<br />C ~. a
<br />x ,4yn
<br />.4 g' a ` 6R
<br />«4.
<br />#~ d°.r $SR~%~'& ii.
<br />YA S
<br />
<br /> 6AMPLE
<br /> MEABUREMENT
<br />
<br />a ~~PER~M~i'(~,~~
<br />'s:~~ ~ <.~~~ ° 9e.$' a'
<br />° i ~
<br />.
<br />`
<br />Fa"'.'r~a a3ga :.>° a ysx
<br />..
<br />"
<br />A
<br />' <iM $,¢fe~..? s~l~x
<br />~ A % Ix.~n~~
<br />f'~:~
<br />w ,aT W~
<br /><~E.sT.l~a'i~tli'e'Sp>?,
<br />~~
<br />~
<br />p` e
<br />
<br />~ .;~y,(g
<br />a &r.Cffi°~
<br />~
<br />'
<br />a• .~~ Bey
<br />~ ~p~`~3
<br />i
<br />~.°
<br /> 'n EOUIREM ENTy. a~ ,
<br />,
<br />b
<br />x
<br />'~~ . ~
<br />,,p-~y,
<br />~^
<br />a
<br />#'
<br />i
<br />r~ s e~
<br />c'
<br />ne
<br />e
<br />" 1<
<br />~
<br />'
<br />~ e.,
<br />S~9 ~8~ •
<br />y
<br />i3
<br />1:'
<br />~ ~g~
<br />$I^
<br />~4'
<br />r
<br /> ^ey re x,
<br />-.f.
<br />< 'k
<br />p
<br />e€~9,
<br /><
<br />,x
<br />a x
<br />e
<br />, <
<br />a3 i¢
<br />t
<br />e
<br />~° a
<br />¢ ~ e
<br />i0 f R
<br />i
<br />
<br /> 9AMPLE
<br /> MEABUREMENT
<br />
<br />~'g ~PERlA 1'1'~®..,~>x
<br />e-?''a .m'e3X g~>% °e'<b
<br />~ y<~ f.^p
<br />'°arlei`~*;Y`~S")~.?~'p
<br />a'+' ~s ap~ ~ ca ~
<br />~ e4,,°pma~s,£°%m°~S ~4r
<br />&~°~g w~.~~E~°I Q%°
<br />'
<br />+
<br />~ ~q
<br />nffi.Tir
<br />'
<br />'
<br />~
<br />g%< s
<br />~
<br />~~e !y~
<br />~afi:Cx Pvf w~BY
<br />ar
<br /> R EOUfR MINT«
<br />E ;~ z;::~;'~
<br />'
<br />Z agg~~55µµ{{.. ¢(~~3°~Q"
<br />Y
<br />~~x `.~~'e
<br />~, jr"".
<br /><~ e
<br />~>
<br />~y
<br />R
<br />-.'F
<br />e
<br />4 .
<br />~d
<br />..,i ,
<br />k
<br />~ ~° s
<br />r+^,re
<br />s ~
<br />`
<br />e
<br />e~
<br /> $s~
<br />~~ e A~
<br />~. ~a
<br />A ;
<br />S, v'ai"
<br />'ha 8r~
<br />O e ,
<br />~4 ~~ 4
<br />`
<br />vM ~x 1:
<br />~4° YS• s
<br />R /
<br />R
<br />v
<br />k
<br />NAME/TITLE PRINC RAL E%[C UTIVE OFFICER PERSONALLY EXAMmm
<br />' CERnfr ugofw PEnALTV OF Lew THAT I NAVE TELEPHONE D A T E
<br /> nN0 IrM FIMILIAR WITH THE INFORMATION SUBMrTTfO MCRCIN AND BIrSED
<br />
<br />1 ~ ~'
<br />IG/ ON MY INQUIRY OF TNOrE INOrV IDUALS rMMEpATCLY RESPONSIBLE FOP
<br />OBTAINrNG THE INFORMATION I BEL2VE THE SUBMrTTEO INFORMATION
<br />/~
<br />,
<br />N YGIL IS TPUE ACCORAiC AND COMPLFfE I AM AWARC THAT THERE ARC SIG
<br />..- NIf ICANi PENALTIES fOR SUBMITTING f1L5E INFORMATION rNCLDpNG G / )
<br />
<br />Press D~kl~
<br />THE POSSIBIUTr OF FIN[ AND IMPR50nMEnT 5¢ IB USC 4 r001 ANO
<br />B NATURE OF PRINCIPAL E%ECUTIVE 1
<br />Z4S i
<br />fo1
<br />TJ Y
<br />f
<br />9th
<br />O
<br />/~
<br />V
<br /> 33 u5C 11]19 rRnalbr. undrr rAr.v rmmrr. mar urladr /.nr. uY er Jlu un
<br />AR A
<br />TYPED OR PRINTED o,ul ~..mar,nrum,nlPrr.nnnlrnr ~,/nrluwn6munln. and ..rvr.r OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENT AND E%PLANATION OF ANY VIOLATIONS IRrlrrrnrr all Wluihmrnls hrrr)
<br />FEki".ITTEE tIUST NOTIFY MQCD 30 DAYS PRIOR TG CO!78INLNG DISCHakG£5-YAk: I.A.4, pG iV. MONTHLY SA`1FLZNG FOii
<br />FN, PLOM E 06G ALLOWED DURING PERIOD CF LTU ACC25S; ATTACH STATEl7ENT :0 DN,R. DETECTION LIMITS--SEE I.F.2.
<br />ERA'Fo' `11( )eF 'f R ! • `J • Iw[P]l1CES 'iw Ro'il rAl' TrNI iaMA. ia0`i,tie~ s[8/{1 N Y G U f'. G L N tt wraa[1 UoF
<br />00034/940412-1838 2
<br />
|