|
PERMTTTEE NAME/ADDRESS /feY4fAWryN~/leeurw /Jq~r.wr/
<br />NAME r ) '. H } •°. ~) L ~ ' ;1 M u p ~
<br />_ =Y
<br />ADDRESS•[,°:; 1,1"•i SOU;, ECKtlAN PR
<br />•.1~. ar~,t R77
<br />FACIIT'
<br />LOCATION-. --,,
<br />~ ~ i 1'
<br />.,.. .~"i9':L ",~1
<br />PERMIT NUMBER .ag 4ENUNem ~ _ t' I ^' .A ?. `~ J ~ I ~ T
<br />MO RINGPERI "r~;:. i ~ P.7gD ,y rn FD~C~1. ;'F~:i'
<br />MO DAY YEAR MO DAY
<br />I D V ~ TO 1 "t ~~ '. i. .i) ,, : ;'" H 4 F G c r !~ ~•:
<br />' NOTE: R~gd Mrtruetlofr Mfoira eoipMtkp ihL loan.
<br />
<br />PARAMETER QUANTITY OR LOADING
<br />Ua) 1 t
<br />Y Or Concentration NO, TRTDUENCr SAMPLE
<br /> ,
<br />EX pp
<br />TYPE
<br /> ANAL~9g
<br /> AVERAGE MAXIMUM '.,UNITS UM AVERAGE MAXIMUM UNITS
<br />',. ~~•' iii ;.
<br />:: C' s r i r !. L Y D I S ti~ L 4' ,; SAMPLE
<br />MEASUREMENT ~•x
<br />
<br />~ k~=:".,k#C
<br />~ I ~S
<br />L (1, I~~ IV
<br />(
<br />T
<br />i I Z~~
<br />i ~' •y j
<br />11 iiJ J U ;~::~PERMIT~::: !: ~ ..~....4,. •c ~dt:.t:
<br />:: ss:: ;t ~.r ...<>:..p: ~ ~^.:##ft'~.>~<`.'? ~:::~~ :If'~rP:O:~:';':.:..
<br />~ ~~~r~,:.T,.~:.Q:~{~':~'::;'::". ..:f ;~~;'.T/ : -': ~3 c:~
<br />;Sr'LJ°:;; -:9JSS VALJ•. NEQUIREMENT~.
<br />
<br />... ~.
<br />
<br />~ : ';'` ~
<br />p' a~'i
<br />~
<br />raAT !' ~Y': M^ .. :. MONTH ~ .
<br />:d. ;, ~. ... .,
<br />'
<br />' SAMPLE
<br />MEASUREMENT .. .. •+k r}k4 ".*`-k ',##4## q ( ii) ~( 1
<br />'~
<br />(J )
<br />=~"~~'
<br />'.1 ?'=~.
<br />: 1: [. i.
<br />I DISS''(.Vf ,O77~ r~2` t~/ J
<br />i. 1 i 1 J 0 ~~~~ ~ ;PERMIT.: ~:. ~ .. i . ;.a:..S ly.. !ti>R::. ~
<br />~'. w
<br /># .:.~..,
<br />..40., ..,.c ~ ~,,:.:xi
<br />,
<br />; v. ~
<br />..
<br />~ u A,
<br />
<br />rL IF~" :ROSS V6:.'i B ~REQUIREMENI
<br />' :.. :.. ..
<br />. .. ~
<br />... ,,
<br />':`:•::.. ..~.;': :: ;':
<br />•.~ s:.'
<br />~~ .
<br />-
<br />:~18C,~
<br />1°~n
<br />:;
<br />T''€~if'': AC T~~
<br />IS.A
<br />:/'
<br />.M (?'i.;H
<br />~ . ~
<br />~
<br />~ r a
<br />. .
<br />,
<br />.i L:. :EASP. SAMPLE r;~ ~. '- =4
<br />R
<br />R
<br />~ '+kF~f #
<br />a .. ~ ~ ( ~ -i
<br />
<br />MEASUREMENT
<br />~
<br />~
<br />j.`~,
<br />~
<br />Nr~ A)/~.
<br /> ,.:
<br />:,.: ~:~PERMIT. :: :~~
<br />":'':=~!-.#~+.
<br />.. ......: .. :. ..
<br />_. ~.
<br />,y.#.~,.....,:.
<br />:.. ~
<br />.:/
<br />Q.~T;R
<br />,,,n.,
<br />`" Ir. '1 T GPOSS VAI UF. REQUIREMENi: ..:: ~:.: ..~ .. ~~.~, ~...:.:~,:~
<br />,.: <:...
<br />,.
<br />.
<br />. .r.::... ;,
<br />
<br />
<br />.. ..y: ..P ~~ .::
<br />..; •. ,e, C:. "ONDUIP -'.i SAMPLE 1 #¢k
<br />.,
<br /># k#{:::'a.- +p..~:41r•; ,
<br />(
<br />`
<br />
<br />r:.T'SaNT PLF.'+i
<br />' MEASUREMENT . ~
<br />(i•C~ I ~. , t ~ ! j
<br />,.
<br />/ ~
<br />1,^~.,;~r-,
<br />~
<br />i ; .; ': L
<br />'D D :;:.:::::PERMIT:; ..
<br />
<br />....... . r' i. ~'~ ~ ~ .:.: . :,,. ~ r
<br />
<br />
<br />~
<br />,.
<br />:^ Mw ... . i`.:::: ... ..: µ.
<br />
<br />
<br />Y,.
<br />
<br />." h '~. .a.::..::. .~1:~~i ~.
<br />
<br />
<br />Q:
<br />:, :. •~.. .. J, ,; :REQUIREMENT ~~:. ~:r , ~ :. .,. : .~ r
<br />r. ~~, ~ ~ ~
<br />.:. .~i
<br />:: .. :.: ..
<br />.
<br />~ I
<br />.: .. ..:
<br />.
<br />. >f ,}:: ':
<br />
<br />~.:..
<br />x;:
<br />
<br />:.:.
<br />..:
<br />l:. '.. ,:,VASE SAMPLE .. ... I 1 .. :.:1 (e# 1k .}
<br />~ ##k# `kkkr( I ~
<br />• ,
<br />-;.. ~ MEASUREMENT ~ /~f 51_S{j!~
<br />4
<br />.
<br />J:'
<br />
<br />),'~ 1 D D :.:..~.
<br />.,::.::..PERMIT::::: ~
<br />;.~.;:< :.. .:::
<br />~ ~.;.
<br />;.::w'~e::r,::+~:r~.n. ~~ ':.'y ;'=.'t;ir
<br />
<br />x.E~.
<br />1 .,.RN....
<br />
<br />~':
<br />
<br />.~i0#:Bf~F~3?4`:'::
<br />:":;"
<br />
<br />~:ai[n;#:~a+.;;;
<br />'
<br />':'' nn.y
<br />
<br />>: :~~v.
<br />
<br />i~NX:LY: rt~w.
<br />
<br />:IS
<br />G
<br />;. F. 1~:. .. ,;
<br />L1~L
<br />.ROSS V.4 ,.J ;,REQUIREMENT:
<br />
<br />.......:... :;.':~~:.-::~~J:::.:,::.. ~..
<br />
<br />
<br />:. .
<br />.<..n,`r.... ... _ ..:
<br />~~ ~~ :
<br />
<br />....::......:...:
<br />
<br />„.
<br />~ ~ ~ .
<br />.
<br />.::.:•::.:.:..:.:::...
<br />
<br />
<br />~ ~ ~ -pr.: >
<br />
<br />
<br />
<br />
<br />~
<br />
<br />
<br />
<br />
<br />~ ~ ~ ~ ~~ ..
<br />".
<br /> SAMPLE
<br /> MEASUREMENT
<br /> :.::..~..RERMIP. ;:.: ~:.
<br />.:.,,.
<br />~~ ~. ... ..
<br />c,.,<.:.:...
<br />~
<br />aa::
<br />~ ... :.~.:.~:
<br />
<br />,.
<br /> REgUIREMENI'
<br />.,. .. ..::
<br />.. .
<br />.. ,.
<br />:
<br />:
<br />>.<<::..
<br />..
<br /> SAMPLE
<br /> MEASUREMENT
<br /> :. ..
<br /> .REQUIREMENT : ::.; :.. ....
<br />
<br />~ .. .... ..: ~ ~ . ~
<br />:...; :
<br />;: ....
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER '°""f°
<br />"p'""f° "'""'"1 docu"1n1n°"""'°'"" "ib"^ TELEPHONE DATE
<br /> pnpnaa °Mer mf El~.rn°n °r npenM°n In nrmrd.~.e wlln upbm dd
<br />M
<br /> f
<br />lo.vurt lbl qunlNeE p.nnnnA
<br />rv
<br />rtl
<br />lM1n nrtl nYUntr lne ln!
<br />l ~%
<br />J
<br />
<br />r.: ~IJ„r(~ `~7~)j p
<br />p
<br />f p
<br />o
<br />eo
<br />w4mnntl.geed°n mf npuirfMNe pen°n er p.n°nr.n°nrn.fe me ryrrem. .
<br />,
<br />:
<br />•~ //.' j
<br />3~•J r
<br />7U-~']~
<br />~~II
<br />t~ivironm:r
<br />[~1 !-!?I'80~Y pr tnwe pen°m Elracllr rup°ntlUMrMpilnerln, Nelnr°mullon, iM1e lnf°mun°n '~f J
<br />~ r
<br />'
<br />~
<br />, wbmllne4lnlnenur°fmftrowYEfrnnEprprr,lnr,wnvnlr..bmmplrlr.
<br />Lm...nua mrn.n afmnnm
<br />rnnne r°r r°emmin
<br />ni mm
<br />nb 610MATURE OF fA1NCNAt EXECUTIVE S °'
<br /> ,
<br />,
<br />rm
<br />w,
<br />~M
<br />E~
<br />M
<br />~
<br />TYPED OR PRINTED °
<br />nf r
<br />p°agl
<br />Ilrf°rnne uq lmpMnnwm r°r ~n°.~nf.~d.uwu OfFICER OR AUTHORIZED AOEIR CODE NUMBER YEAR MO DAY
<br />OUMM[N I S ANU pxYLANA I Wn Vw nn t Y WLA 11 VNS l/bf~.~nCI N/ /fbCDTII1f0 /11lI/
<br />i'~ I. A~`... .. 4L.I' i ~.. 1 i, i J (I '):. ' .'' 1 .. !J L~.` 'r i, ,- r . :.p' "'' ... ' . ., i T ~, ~ ,.9 i _). ~. ~. ~. }
<br />1, F'~[i1k:`:n i)i' ifi1^'r' ?`'~UI9va:' ..,. ^''.',. ok"~'. -°i ~. .1. D,.. i.. Th
<br />EPA Fwm 3320-1 (Rey 3/99) Previous editions may be used. 0 ~ ? 2 5 / 01 tJ531~ ~ a $~~IQf'TI~ PA°E Z F
<br />
|