|
PERMITTEE NAME/ADDRESS pwd,b FecdrryNadLxaum rJDt8lrrao
<br />NAME Cvi,. .. _ _. .. '~. -'_40~
<br />ADDRESS~ /.-jA (. 1 r . -~ ~ ... I - ~ -. p _ ~ p .~ , K
<br />FACILITY
<br />LOCATION
<br />.. 1'T `iC ". ;]'ti- r~T.°Y. ~AT. .ST`I '!
<br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM (NPOESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />11-361 I7-19
<br />'CO)Z71i'J rn1 e
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ ~ TO ~_
<br />!14111 /11-131 114151 !36171 lI9-191 134311
<br />- Form Approved.
<br />^.• .. .. ~ .; -,~ . ~ .. •. GMB~Np= 2040-0004;
<br />r^ ~. ~, „ .1 Approve expires OS-31-98
<br />!
<br />r _ ~ r
<br />,, Tr•%
<br />A~NOTE: Reed inetructione belwe eompletinp thu Corm.
<br />PARAMETER !3 Grd OnlYI QUANTITY OR LOADING !4 Grd OnlYl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !4653) !5457/ l38-451 14653 /54511
<br />EX OF
<br />TYPE
<br />l31-373 ANALrsls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsI
<br />e]1 54-581
<br />1 /5?701
<br /> SAMPLE ~~~=': .^+4#'.` ie'•:'~:'•:%= ~ `~~ y
<br />yJ -
<br />1
<br />J~ G
<br />~
<br />n
<br />17I'AL Rd_lY;+t. /' MEASUREMENT ~. ~S ~
<br />~ • Z /- 31 ra
<br />./D'l".D 1 D '~ PERMIT J^O:L,'.r *tw:yxtr r,..~^- tY,Y##'kfi 1.0 D°Ft)^? " RRF'`?/ '?A'
<br />F;r1jc;•P _~~cc N.4LU.. REQUIREMENT ~ $.+:x r: ?R#1A AYG pA7TV rX ~.:/!, N7N7''~
<br />;ILVt;R, PJ"°4°iALLT'
<br />-
<br />~
<br />~ SAMPLE
<br />MEASUREMENT ~r;L2:t0",i ;t~~.~>r{: rk',R¢f,:D-`
<br />~Q
<br />Q Qp
<br />~
<br />~D~s
<br />Q ( 19)
<br />~ I
<br />/3~
<br />G
<br />6
<br />iSDLV
<br />.^.D
<br />I .
<br />j .
<br />, /A
<br />J1JC4 1 I' ) PERMIT +k#ttxRi #.".#OK~ ##^ ?#a"-Lr#C Rf P'1't" RFPO?1' t MCRr tQ~t'
<br />,~Fc LU Eh"p GF.~S' VALtI-. REQUIREMENT r. rr0 3'.10A Ilt" .iJATLY M.X 'IG/L ~ 110®1'N
<br />~.:''PER~ ?OT'"Tt.=1.T.Y SAMPLE
<br />MEASUREMENT :'.^:k.^•'= :^•PG{c .k ..;tDA
<br />LQ•~oI
<br />L~'17D1 ~ •q)
<br />N 3
<br />3~
<br />/
<br />G
<br />~
<br />.Ii_~.7LV.':"~ , yq
<br />~
<br />;r-,o 1 D
<br />
<br />; PERMIT 'k>YrAk?r~ :',:#rR# l.::k: ~`.##r._,. D,~'1.~ r~.., ~
<br />e, ;!
<br />4E?/ EF.
<br />:P
<br />`'~L'JEHT ;RJSS 1~'L!'E' REQUIREMENT :yD gUnF A9f: LlAT1.Y MY `1r/L rORT;t
<br />IL:„ar;FS°r TDTAL SAMPLE .'RSGS Ctr04T Crt#~;~~-r,' ~ 7~~ Q~
<br />/ J
<br />_C !r ~•rZ?+1LF MEASUREMENT ~, ~ 1 ~,1~p N 3~ ~jrp1J
<br />~i L1? 1 U ~ PERMIT ~.: ;:-tr=;t7R e7.fft El4>k~• .. .-'k#^. 's:k R$7t(,t°'^ A'~'Ar7TT "'^'Kf.Y
<br />D 7 ~
<br />r
<br />L C c''' : ~ P, 7 ~ ~ 'r t L '' c
<br />gEQU1REMENT^ r'
<br />~
<br />-,
<br />
<br />300 ~Y:^
<br />
<br />T`i.T'L1' 1RX
<br />
<br />/I
<br />_
<br />`'' •. I;! C7y'."i p
<br />"
<br />'
<br />"
<br />M°
<br />''
<br />' SAMPLE
<br />MEASUREMENT
<br />~~
<br />a
<br />~Sb
<br />Q ~ J3) -. .... (, +. '. ,:.r ,'. .~...-#w~_
<br />~
<br />~/3
<br />~r
<br />~
<br />!IP
<br />!(
<br />=
<br />i~1aU 4
<br />0'1
<br />P . • 1 ]
<br />•
<br />5U05D 1 D U PERMIT $"9JiF 9R71:rr•
<br />. _ .... ...._... ~...Y
<br />. ,,. .... .,y,.....
<br />, r -...- «ti .,. d-
<br />v..f ~~~ . ~'r• i r-• i v
<br />r . ~~ ...
<br />.. A .
<br />'IS
<br />~FFLC? ~?JSS 'lAl.'% REQUIREMENT 34{)A .AY.r. DULY "Y RIGD +`•;T'::•.
<br />
<br />iI L .'.",) .;F?FA ::
<br />SAMPLE
<br />MEASUREMENT
<br />D4`0*F: -:`
<br />~+
<br />CJ
<br />( 34)
<br />fi•'•;'s:..;
<br />.: .k#~«r.
<br />«.•,:_...: -7
<br />r/
<br />~
<br />
<br />_,, -~
<br />/
<br />J
<br />3 IS
<br />.UU.•5 '. 0 ~ PERMIT ~~;-RG3 Y cS=1 ova axtt •, e•ty#:tf ,°,• ^-'s ;: ~• ov, Lv ~•~nET
<br />-:'L'.' ,. f '~R:,S 'i '. ~ REQUIREMENT TY3' !!AY H7=1 ...
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDFR PENALTY OF LAW THAT I NAVE PERSONALLY E%AMINED AND
<br />MILIAR WITH THE INFORMATION SUBMITTED XEREIN; AND BASED ON
<br />~
<br />' TELEPHONE DATE
<br />
<br />~
<br />I
<br />h
<br />l Mill MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS ~ ~
<br />~ ~
<br />~
<br />arc
<br />:
<br />c
<br />s ,
<br />TRUE. ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ARE ~
<br />(~
<br />/
<br />r, ~
<br />
<br />ii~lvirnnrsental :/< ~urfli-
<br />-
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING r
<br />y ~,
<br />,N
<br />Q7D 87D-717
<br />~ ~
<br />~~
<br />;~
<br /> THE POSSIBILITY OF RNE AND IMP11150HMENT. SEE 18 U.S.C. 1 1001 AND ]] g10NATURE OF PIIINCIPAI EXECUTIVE
<br /> U.S.C. f t]te. fArWl„ un4~r drr Nom, /rr,Y Ax.Y.W Fxwa up ro Pr0,000 AREA
<br />TYPED OR PRINTED wwnu.:m.n hLa/smtrH Oralw»rt srenn,wsF.,ral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLA 11oN5 lReFerence a9 sttscnmenu oars/ ~ ,
<br />,•.L1::RN!.T: LT~T.,- Cp .;}.T"'L'?.9~r'. 'lr~Oi (LAC rlr) .'~''nT.v n"iq Tc i_ 1.._ 91(-+'q °' ."~ ;1'-:
<br />CL.IICF::~.. -'I'. C.'.7, P' 1", F:- Iv,~gr, ~ nq~ ~ r~.,.r~cT.J~ r.T r .-r, __~. ....rt. ^
<br />EPA Form 3320-T 108-951 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ^ ~ ~..~ /„ n n;l n -r _ ~ :~ ~ r PAGE _ OF
<br />
|