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PERMITTEE NAME/ADDRE650~6Fr4iryNaa/focaaw dDlQwwrJ <br />NAME PU:uLNHI`k;. (-(ILL :':,~•.'eAh7 <br />AooRESSr(u;Lu:I"!: .ir.-:, ., ., FOATAL', <br />F.J. r:. .( i. ;~ <br />PA+.i:+ASi; <br />FACILITY <br />LOCATION <br /> <br />. .,.. Jar. ;. .:,~l,;~_ -~:.),~~-- <br />Nwrlo DISCHARGE M~RORINO REPORT % Mg1PDESl <br />11-161 17-191 <br />CUOU27146 h5~ C <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM y'J VI+ U TO -/ I J!, .;V <br />lT4TILlTTvT3Ll7!-751 __ITB77/ !IB-T9/ 13637/ <br />form Approved. <br />ACUTE MoT TE:i?-HO~M,~Ko.J 2044rOg0~.T; <br />(SULK MC) APProvel sYp~ree 05-31-98 <br />~ - FINAL 111 <br />;'ItiCh <br />NOTE: Raad irntructlorw before eomplatlnp thu form. <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION NQ FREDUENCY SAMPLE <br /> 146-531 !5461/ lie-451 176-53 /54671 EX OF <br />l3T-371 <br />MALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is1-F.T! 164661 169-701 <br />.... `,i n. :.c :. ::. ACL <br />' SAMPLE <br />MEASUREMENT :Cr :::{= .•::4.-~:: ,7 <br />, I DO .. ., t:p <br />( ~) <br />Q <br />_ .. ~ U::n i'tt <br />• F <br />~. ::t w t. <br />- PERMIT n>::l •}:k rt y^. :~.".r ;r';:'v0 L.. t n9(!1 <br />IJL . :IG t.'E C*? il.l >; t}'I C< c~w_ <br />; <br />:TtiLY <br />;i7AF. <br />:r:.UG(~l ... VALUI: :REQUIREMENT {:~t;.r,: ~h y.AL{)t CF. `:T <br />.. .. ~, :,Tdl'n. ,(. !.{ AC <br />y SAMPLE ~?t: ;: ~::<%t -, .. ;•ri is a:flG. r,~%... :fC ~:y •:C ( =3) ~ <br />r>, :,tt'Nhv_..~ MEASUREMENT \ <br />/'~O O /9 <br />n:: I, L, 1 •~ (/ ~:: PERMIT' Gfrft}=.tyf ~; ~~ .a>~+iCFtC ..~ Gr{: IQs7 eQQ.Q1 Q'.•U4d~i ~~O.F};IM'D~sk~~ ~: p~- l ~TliLY =R7lb <br />:.t l LGGO i ..JSS V ~ L. ::: :REQUIREMENT ;Ir?.C'; ysd YA.LUE ~ ~ ~ ~ ~ C".N°. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~:~. PERMIT <br />~ <br /> . <br />REQUIREMENT~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM fA FY UNDER PENALTY OF L <br />MILIM WITH THE INFO AW THAT I HAVE PERSONALLY E%AMINED MD <br />RMATION SUBMITTED HEREIN: MD BASED ON ~ <br />- TELEPHONE DATE <br /> <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR 1 <br />~ <br />~ / <br />01}/ <br />1 M • f~LTFV L OBTNNING THE INFORMATION, I BELIEVE THE BUBMITTED INFORMATION IS ~ <br />~ <br />„ <br />C <br />TRUE, ALCUMTE MD COMRETE. I AM AWME THAT THERE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING j ~ <br />U <br /> , <br />P ~ <br /> <br />1 ~,~ . <br />THE POSSIBILITY OF RNE MD IM <br />RISONMENT. BEE 18 U.S.L. ! 1001 MD ]] / <br /> <br />BIONATURE OF PIIINCIPAL EXECUTIVE <br />- <br /> u,S.C. ! t]Ia. lPnW4. u.er el.w mem. n+Y M+cah r.ws ty ro f IO,OOD AREA <br />TYPED OR PRINTED .red armuHwninprlowwNOrblwwn FmmNa.nd6 y.val OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell eftsehments hare/ <br />.. ., .. FAt(: :. n.4 FU~ CLT!•.Ii,.. .P '._ YnU;:c~7nE, hP'L 1.C~f5~ ~ILi1Ti0R ("OC FL'"'':'f) 4111fCH f.; Lr'~!IAL 'I( ~,. OF <br />1':.~1 Ul=,.,n:IISh"i (L~~O) .a5.~'.:: r. .,J i`. 'I.).BICTTY 'Ti:_.. ne.?~~r.T F't~H° 'C(^, 0":. CU:,'_'.~ Lr ALL Ii, F'L; ""J1:T .•L F.'1T <br />. f MM TT^'-r .I,t. <br />~ ~•, '.,r c --1 ~~;. r-n~T w.- nT err rDnr nnT: r:~ •I oun•ncn r^ :.. m., +u ~ r~ ~ .~. <br />EPA Form 3320-1 108.951 Previous editions mey be used. /REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.! C ~ i,1 ~ ~ .L 21 C i ` ~` - I Z r r_ - -P GE ; OF <br /> <br />