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PERMITTEE NAME/ADDRESS ptlr4fslNryNa~'lacmla dD~p.,.,,p <br />NAME TEdfl:1;? ~;2E~.C ~0'!PANt <br />ADDRESSTEHROd JdEEd LJAJJJT <br />1840 HIGHYA[ 133 <br />PAONIAT O 81424 <br />FACILIT' ~ ~~- <br />LOCATION ~ ~ ~, { Y"~ <br />ATTN: KELLY PBLTZLER. OPSRI?I l~~R Ff <br />Fonn Approved. <br />DOGOOT POND TD N t~°• 1~9t9~N <br />($DBR YC) PProvel ex~I~jO 1-98 <br />F - FINAL 1L <br />BI1101~' <br />:#3 ND DISCHARGE ( ~%~r <br />NOTE: Reed Instruetloru before a mpletln0 ~u torm. <br />PARAMETER !3 Grd Onty1 QUANTRY OR IOADIN !t !yF 4UANTITY 011 CONCENTRATION NO. FREQUENCY SAMPLE <br /> A6531 15s-61/ 3851 Is-63 161-611 EX TYPE <br />131-371 AVERAGE MAXIMUM UNITS _ I IMUM ~ AVERAGE MAXIMUM UNITS !et-e31 ANALYSIS <br />lµsg! !s&)Ol <br />~'d .iE SAMPLE ~~~+~~ ( a-) #ii#~" #$# r4 r+rr~ <br />I S 0 -L MEASUREMENT T" <br />.- <br />.:. <br />4066 1 O ;) PERMIT #~vt=~F# .. 11~ <br />: <br />t <br />i ~S=L '><~': ~ __ p.. :'I~a~!~I..# "S$i##'~. ~ #Y.- REKL[ I$UAL <br />PPLDENT ,:ROSi VAL'J° REQUIREMENT . <br />. <br />.. <br />~.B ~' <br />; ". <br />D <br /> <br />~ ~ . <br />;?,'~A«~ <br /> SAMPLE ~. p ~t:". ~ I," <br /> MEASUREMENT " ~" '~ r"'~ <br /> . <br /> ' <br />PERMIT .. ~::: `: <br />:: : ". :. '.::(~:::::.~.. ~'..:~~ °~. <br />~~ "::~S."F: <br />~ <br /> . <br />.. . <br />. <br />. <br />. ..y.. .. ....r 1': :... ~' <br />'. <br />~ : <br />' .. <br /> REQUIREMENT .~ .. ~ .. ~ ~~ ~:~: ." ~ ~-~"'3c~:.'z•~':'«.':. <br />~" ..:¢ <br />a <br />.< <br />.: i.:::: .. <br /> SAMPLE , ..ii q: <br /> MEASUREMENT ~^ <br />.~Y <br /> "PERMIT ~ ~ ~ ' <br /> ":fiEQUIREMENT~: ~ ~ <br />:. <br />:., :y.. .~: <br />~~~ ~~ <br />, <br />,. . <br />~~ <br /> SAMPLE s~ <br /> MEASUREMENT ;yy~ <br />.. . = <br />~ <br /> .. PERMIT. :~... .:. :.,..~ <br />~ <br />~ _ <br />. .. <br />" ::REQUIREMENT ..... "~': "::.~.~ " <br />. <br />..~. <br />:. <br /> SAMPLE <br /> MEASUREMENT ' <br />r <br /> : ,. <br />~> <br /> .; . <br />.REQUIREMENT .. ...~ ...: ~ ~ ~: ~ ~:~3=`, ^". i:4•.: ." . <br /> SAMPLE ~ ~ ~~ <br /> MEASUREMENT <br /> 'PERMIT: ". ~.. ... ~ ~ ~ :~~:. . .~: ~.~ ., ~ .:. .. ~. ~ ~ "" <br />. ~"pEQUIREMENT <br /> SAMPLE ' - <br />- MEASUREMENT _ <br /> . ~" PERMIT.:::: ~ <br />-. <br />~ ~.; ,.:...~ <br />~, ..:~ ... <br /> ... <br />REQUIREMENT" <br />'~ ~~ ~ <br />~ ~ <br />~ " " " <br /> <br />... <br />~ <br />~~ <br /> <br />~ . <br /> :... .. . <br />~' <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />T <br />F UW THAT I HAVE PERSO <br />T NALLY EXAMI <br />MD B <br />FR NED MD <br />AS TELEPHONE DATE <br /> AM FAMILIM NII <br />H THE IN <br />ORMA <br />ION SUBMITTED H <br />DN: <br />MY INQUIRY OF THOSE INDINDUA1s IMMEDIATELY RESPONSI ED ON <br />BLE FOfl <br /> OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORM ATON IS <br />~ <br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT TH <br />SIGNIRCMi PEMALTIE9 FOq SUBMITTING FALSE INF011MATION <br />IN ERE ME <br />CLUDING ~( i <br />ELLY FRITZLER OPERATIONS MGR , <br />TNEPOSSIBWTYOFRNEMDIMPRISONMENT.SEEIBU.S.C.It001 AND7B <br />OF M <br />E <br />' r S 10 28 <br />TYPED OR PRINTED u.s.c. E Tale. lFbrNV, uMr dwr .semr• InFr iN'AA, sn, w ro r roaoo <br />,nd or m,Fils,n iryviawwlrW brrwlemmeu rNSrv+l I!~M AL EXECUTIV <br />BIONATIRiE <br />OFFICER OR AUTHORIZED AGENT CODE NUM ~ VEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rderence el/ sttechmmts here) ~ ~ - <br />SEL1LBlBLE SOLIDS LI'fIr APPLIES ONLY IF C= LO-[RA 24-HR PRBCIP BYL~YT IS CLAII".ED. ZF CLAIlI.lYPROiBD BT <br />N~CDe ?SS 6 IRJN LI!'IITS HILL NJT 03 APPLIED TJ REPORTED 7EASUREtlBNT5--5 E I.B.lAF PG 5 AIID ie~.1DF PG 6. <br />EPA Fqm 932Q-1 10&961 Previous editions mey ba used. IREPlACE6 EPA FORM T-00 WHICN.MAY NOT BE USED.1 Ol5O~Q3O9~,, ~ ' PAGE 2 OF <br />