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PERMITTEE NAME/ADDRESS P„a~m FrwryN~/L.iilla.y/D~in) ~ , <br />NAME ~ POyDERRORN r_OAL COMP~I~''t <br />ADDRESS ROA DSIDE "INr:, ;. ; 5 PORTALS <br />e.o. aox I4so <br />pALI5AUE <br />C6 3152D <br />FACILITY <br />LOCATION <br />i:ih: JUTIti A. 'f.:VAo, FiteSIL'~E„!T <br />NAi1DNAL POLLUTANT DISCNMOE El1MINATOR SYSTEM /IVP-(IE$'/ <br />DISCHARGE MONRORINO REPORT IDMRI <br />I1-15/ 17.191 <br />PERMIT NUMBER DISCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM U lU O1 TO CO 1?. 3L <br />!141/1 I?1-131 111-15) !1617/ lIB-191 13631/ <br />ACD7E >!E? TESTIRGG~ ooa 1 <br />(SUER yC) A ~~e~05-31-98 <br />ul <br />F - FihAL <br />9I'•ICF <br />NOTE: Rud Imtructiorla bafori 2Y6KIplatinp thin form. <br />PARAMETER l3 Grd Onlvl QUANTTY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> !46531 !5457/ l35-151 14653 !54611 E L <br />131371 X y515 <br />MA TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-s31 15q-5g1 159-701 <br />L I.JV' S1'AISG' 4dKR AC SAMPLE ##R~r# ####~# ~kT-~:: :#C •',: C;.'-JI {:;; { 23) <br />.~eJ:1G~AL'ilh{A MEASUREMENT <br />. n~~Jd 1 0 O PERMIT: ~ ~ ~ #C4R3m <br /> <br />~ 4>C191;1p# #-'.' OO.QODL rr#~Xl4fs ##4#.3 `r <br />En- <br />SRL7 : <br />:64 <br />D <br />•. F'r :,UF. ;: 'f ..2.055 YALU: REQUIREMENT ~ ~ ~ ##r? . <br />i. 1, i.l ;i T•, i':i t. 9tiHR AC SAMPLE #$8#G'--.? #####~yF #F?3k### ^>:##K~# ( 23) <br />i L r i <br />~, ~ MEASUREMENT <br />, _ <br />.AI,:-C i U O •s,::. PERMIT.::: ##!601CIiS :: r~+~S~PO;O O#C f0"Q <br />.Ott(11 ll+~ilvtDO ##IOA## EA- ~FtLl <br />: ~i8 <br />.. i'e LUl;hY hi;055 YALU REQk11REMENT ~ .. ,. ~ ~ ##G# . <br />- ~ .. <br />~ p . . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~REOUIREMENT~. ~'.. <br />,.. . <br /> SAMPLE <br />- ~ MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />` <br /> PERMIT ~ ~ ~ ~ <br /> REQUIREMENT <br />NAMERRLE PRINCIPAL EXECUTNE OFFICER I DERTI <br />AM FA FV UNDER PENILLTr of <br />MILIM WITN THE INFO uw TNAT I NAVE PERSONALLr E%AMINED MD <br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR , <br /> OBTAINING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION 19 <br />- _ <br />• '+ r't/ IVY' ~ TRUE. ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME <br />SIGNIFICMT PENALTIES FOP SUBMITTING FALSE INFORMATON <br />INCIWING <br />' <br /> , <br />THE P <br />651BI <br />TY OF R <br />ID <br />MPII <br />SEE IB U <br />1 1001 MD 3J <br />E <br />SO <br />F <br />T <br />S <br />C '71 2 4 i <br />4 7 ~ 111 Q ~ ' ~ <br />_ <br />~ O <br />U <br />N <br />M <br />I <br />I <br />NM <br />N <br />. <br />. <br />. <br />. <br />' BIONATURE OF PRINCMAL EXECUTTVE - . <br /> U.S.C. ! 1310. fHM <br />Y+ rotor N+r mem+,nFY AxA,d+ wr+ IO ro JIO,000 AREA <br />TYPED OR PRINTED ens ormui+Nnr/"wnaaanwtolMfwwn smmel+aiM 6Y+ra.l OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRSference s// ettschmsnts here/ <br />~c,c pAHT I.k'.LL FOA CN'iF ILS OF 'P°ST YAOCf:DUXd. itE PORT LOJP ST Di IUTICy (: '':FFLUf D?) Ai!ICH IS LETHA~~ 1'J SU: <br />vF TEST UHGANI5C5 (LC5J) ANU ATTACH ACUTE TOYICITY PEST Re"POAT FCRH TC EYR. COPIES CF ALL INFOAI~6I'UN <br />EPA orm a~2QTIOS-951 lPrevlous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) D 079 P / 9 8 G 2 2 3-12 5 5 PAGE OF <br />1 <br />/ -I <br />