|
PERMITTEE NAME/ADDRESS (I.eY,4 FxWryNe./!<cenm dDN...,N) NATIONAL POLLUTANT DISCHMGE ELIMINATON SYSTEM (NPDES)
<br />NAME C C p " ~ '~ ~ • ~ ~ -- ~ r- n ~ DISCHARGE MONITORING REPORT lOMRI
<br />!Z-I6l 117-191
<br />ADDRESS .K,;V.: r- ,-. ,-.,.r ,; '•~' i? r~ ~~77~11)1 n1~ A
<br />/y~Cl ~' ~ ~., ~ '~.L ~C'f: L' PERMIT NUMBER DISCHMOE NUMBER
<br />T ~N ~ ~ `~ ~ iT y' MONITORING PERIOD
<br />FACILITY
<br />YEAR MO DAV YEAR MO DAV
<br />LOCATION FROM `I~ - ~ TO 'I° l f• '1
<br />• ~' ~"~ 7 t7 ! `•' 4; ~: ~ ~' ; I E'!. :i a P. L .q 1' 'I r 170.111 177-131 !14151 116-I71 f18-191 130311
<br />v.V i n.~K•1 _,
<br />F
<br />( :D X511
<br />_ c•utl
<br />ra ,.~~
<br />Form Approved.
<br />r ~OE~B.No:.20,40-0004 - .
<br />Approve, e;c{)irea.05-31-98
<br />ANOTE: Reed Inetructlom before completing this form.
<br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !4 Grd On/yl QUANTITY OR CONCENTRATION ND, FPEOUENCV SAMPLE
<br /> 116-531 15461 !38451 146-53I !5451
<br />EX OF
<br />TYP
<br />I37-37/ MALrsls E
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !61.6]1 164661 159-701
<br />.~,r SAMPLE .. :;:t0 `~3:•.;: ~: t: •:::: y~~ ~9 _ ( T,) p~f s
<br />/ ~ I
<br /> MEASUREMENT x.99 0~~, f 3 C")(IXb
<br />'!;':J;i 1 :, PERMIT 4'v0?XR X#~#44 :x ;:. r,.5 ~ -: x^+#r:r:`A r,." '9?+'S.Y ;na<-
<br />"' L U g'. T ~~ ~;; V R L U F REQUIREMENT. ^?~ "k K[ jQ Z!!(IS!" !E A F T"I)+ S r!
<br />i,;L::15
<br />'1"JTai SAMPLE Ch ;t 4t i'J :4404 >:s4Q+e,!"'
<br />~ ( la)
<br />,
<br />„
<br />~ SUREMEN
<br />E T ~ _
<br />-
<br />n ::
<br />£ s ~ e r, M
<br />A -
<br />.)U•.1R C C U f?ERMIT #%X471## - 40?0R# ?##Ln4fi RF p~qr 9£.PO RT t "ti ^, F/ ;,IRE.
<br />- C~~?fy~NT:: '1 ~'L~li REQUIREMENT ^~0 3RUA AY!' I)qT~ Y 1'".1f rr,/L M.:),1^ar
<br />'U~.•LJSr TOT!L SAMPLE ~'`-h'=~'=n ,.. .- ( i'1) /~ 1
<br />/
<br />~
<br />i ,f l P£ N U E D MEASUREMENT ~ 8 ~$ JE/ ,3 I .~ /QI I
<br />~L: Jr) 1 0 ~ PERMIT ~Ci+O'F; f.`•0'XV4: 4 "r. ":f ;~:x';'4 3~i 7i) r ,.Vz/ -0.4 j
<br />. FLUENT CaR7S5 VA L'~` REQl11REMENT -^.:~~.~. ~!1 (' ~ 9y'• U.qT LY T!1 ^'~/L )s. m,~
<br />'+
<br />-
<br />
<br />.^:.IDSE St.TTLER''L"
<br />SAMPLE
<br />.!:'rte?:=
<br />4r4Fr`-~:
<br />~:~.~,..,.
<br />N
<br />NA
<br />( 7;~
<br />/~( n
<br />~
<br />N /~
<br />
<br />MEASUREMENT q
<br />S(/ I} NA
<br />~0i4`? :7 0 !? PERMIT,?-'. r~+',:.k'L4 00;t##4 , "+._~ t:~r'a4'+ rl•-~~''T ~ ` ' ~'(;-;/ ~TA';
<br />.. COMMENTS " i. 'l~.i REQUIREMENT ~ .. 31Tn0. llYt+ rq T L~ !1X °T /T.
<br />` »~vr r
<br />~''. !.I DS, SETT+. 'L~; SAMPLE -.. ': kG~? 4#0".r t: : ~: "r04t=:`
<br />~
<br />~
<br />(
<br />)
<br />~
<br />i/
<br /> MEASUREMENT ~ • ~- Q . ~ 3 ~ ~ /q lj
<br />:115a 1 (! C PERMIT .-•.4*•~ ~7~".:0#: .. 7"X:,IA..,x ornr/aT ?':'p~~T y^'~/ -+„
<br />,
<br />"r'PLfIf.N': = 1'1-;5 7A!-UF REQUIREMENT w:~0t T1n4 AY'1 Dl7LY MY "-./L "'0':"'"I
<br />)I1. ANi1 Sr.:gSF SAMPLE 'f000?-: r~:t0«:• ;Y~.y r.x.. .r r:•: ;r ~. •: ~/ ( Tci) ~( ^
<br />`''t +'li' :X""i~~.rt 0.Y Y~R'' MEASUREMENT rV~ JV N`7
<br />)U~r. fi ~ ~ Q PERMIT ,-,007tC -'.'-[hYP C'.`- ?:.`- ~?~:f: ~•Y•;~ r#it!!'-:f= "^
<br />'
<br />puTi:
<br />.vin
<br />^:F=LTG'`!,!. ..I1J~5 VAC'!` REQUIREMENT 40;7 TygT r.q7, 'I':/I. S'•''1T
<br />. :il~~•r ~ J~. SAMPLE ~•.•t ,-;: •. •:;: '•:`-r: .. ( 'I ~~
<br />
<br />(A 5 ~ .'. ~
<br />MEASUREMENT ^
<br />r `I A „
<br />N r"T
<br />~a '1
<br />N I'1
<br />lr't ^. 7 D J PERMIT -:u: - ..+ ~=>: !:b. s;x r%x Xt«., ncCFtPT n... pn-. q. ! ! ^L:/ Iql,
<br />~~ "')H 11: ,,r ,!,-:; REQUIREMENT ,. ?nilA AY^ s,AT:v MV "./I~ '~'~,; .,,
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERT
<br />AM FA FV UNDER PENALTr OF LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INOUIRr OF THOSE INDIVIDUALS IMMEDIATELY RESPONARLE FOR ~
<br />~ ~ ),
<br />..iCil3YCl Ii~S
<br />OBTNNING THE WFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ -
<br />/
<br />~~~
<br />~'l Vi Y0 Y1 Ptf?!'liul
<br />1i1 e
<br />I
<br />3 TRUE, ACCUMTE MD COMPLETE. I AM AWARE THAT THERE ME
<br />SIDNIFICMT PEMN
<br />TIES FOP SUlMITTINO FALSE INFORMATION
<br />INCLUDING ~
<br />~'
<br />' ~ /
<br />~
<br />,
<br />.
<br />r
<br />g .
<br />,
<br />THE POSSIBIUTr OF RNE ANO IMPRISONMENT
<br />SEE 16 U
<br />1 1001 MD
<br />S
<br />C . S7 Q 3 ~ ~-77 ~ 2 j ~ ~ ~ I~ fS
<br /> .
<br />.
<br />.
<br />.
<br />]] 610NAlURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. E 1 ]I o. lw,wn. uw« drr moms m.r iNA.a4 rxws ip ro J I0,p00 AREA
<br />TYPED OR PRINTED .r,0 ermvnlun bArsmrrt olbrwwn FngnlAaW6Ferr+! OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAy
<br />COMMON I a wrvu eArlwnw I Ivn yr wnT v1vLw I Iona lrtererence en ermcnmenrs oars!
<br />r.Ll `.FAA?t' LI"I" v;1c .r faDv ~. TTL`:A°~" '7T.I?r (',~^ r., t) ql, rTV 1,•rv Tr ~- 1'-v yr )q_iD aq.. ..I _, cn ,T
<br />%'.,•("'E~U.• F.' i. \.-'• .. l;i• F'.1~ 'Ji`1 E.b 7F n'17 x' -.C .~lirr.v^ym-• ^IL ~.,z~.- _-. ,r.T ... .,. ;/ -1^ .
<br />L PI'IV '-E'"Df iy^ ':D^:'TTl TCPT I'1"T TnU _l ,n".v n+.C fl/
<br />EPA Form 3320.1 108-851 Prevloue edltlone may be used. IREPLACE6 EPA FORM T-40 WHICH MAY NOT BE USED.) ~ ~„ r :- r ; I ,. ~, ,~ 7 _ .1 ~ T „ PAGE OF
<br />
|