|
PERMITTEE NAME/ADDRESS pri.L FrYgNaWfarla yDll!•...q
<br />NAME :T P.t i. '/' ~-.1 ~. _ -
<br />ADDRESS )•1`~1 Eii LF?,~ '•''J'.' F '~1"~'~ ,
<br />,,~Y ZNGLE+ 77' _", 9'n gs
<br />Facam
<br />LOCATION
<br />._~NS M'J4~r', _'r,'fr ,
<br />. m.0. :'. RT+I"7
<br />NATIONAL POLLUTANT DISCNAflGE ELIMINATION SrSTEM /NPDE$)
<br />DISCHARGE MONITORING REPORT IOMR)
<br />!2-rsl n7-lsl
<br />~~~%271?It r^9 ~
<br />PERMIT NUMBER DIBCHAROE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM "`i ;; ~~ .~ TO '?"
<br />tlQ]71 tl]-]31 (]4]51 08-]71 I]8J 91 /3Q311
<br />Forth ADProved.
<br />~ m-OkQ&No.,2040-0004 .-
<br />• r ADProv expires 05.11-98
<br />*n^
<br />A NOTE: Raed instructions betora complstinp this Corm.
<br />PARAMETER !3 6rd Onlyl QUANTITY OR LOADING !<Grd Onlyl QUANTITY OR CONCENTRATION ND FgEOUENCr SAMPLE
<br /> 146-531 !54611 138d6J 146-63/ 154-67/ EX DF TVPE
<br />l32-371 ANlursls
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e]-8]1 !54681 !69701
<br />..I'•i:'JC'fLVITY SAMPLE t:rte:r•'c .--pg•::t ;:-er:,::..:.
<br />~ t))
<br />{
<br />~
<br />~ ~1~t
<br /> MEASUREMENT 3'~~ D
<br />3J D ~ F.jQP~P
<br />~1L'1::14 1 !1 U PERMIT L: r,:~b#t ;r4rror«: Y ^r..'- ~;. ~:rc>;:w PF. P')R'* ,~n'^T C1\Y. ' yl: r;/ I I^LY ;R.i"
<br />-F`'LC5\"'4755 YA, !.U` REOUIREMENT ~~;:;
<br />Os'.TA AY^ p... M
<br />F .. AX (...
<br />_
<br />2.. SAMPLE
<br />MEASUREMENT '`-ro(KroG~ ~:`~ ;: . ... Q
<br />O ~~Y+.Y, ~IJ ( IJf D J~ *
<br /> vr F
<br />tCJ
<br />71.'300 Z 0 •7 .PERMIT aaaroxa :tYt:n:~r; ~: =x4s 5,5 ;';"-r,.ro~~ o." "• F.;"~~i.Y~ •''.4i1
<br />'c~'LOk: ';FOSS V!<i.!IF .REQUIREMENT firs'TO TL 9T"!'1 `! srSY~T n+3M C^
<br />OLLOSF TOTAL
<br />'
<br />" SAMPLE
<br />MEASUREMENT ...... ^::~:;::;: .,t.T"°sr ~
<br />A
<br />~
<br />N/ ~ ~~)
<br />O `,
<br />1~+
<br />i 0 i F f': q 1'
<br />D A
<br />7U': )0 ) D 7 PERMIT :=~:ror. ,;:F,:a¢>•a .. .- !.!-.- ^sp^.:m 'r F.PC~^'* r R^^/ .~l
<br />5''] ;:Or";;HTS 'i^LPM REQUIREMENT r: •rS~ 3nnA 40~ *1 iitY "lY •:;/T. '5:11:'^'
<br />~:7LID-SF TOTAL SAMPLE .. . ~ `•:::r:r,:':: •... .:
<br />~
<br />~
<br />( 1 ')
<br />D
<br />'1
<br />U S P F. N 0 `. U MEASUREMENT 3Q ~'~, 2A,5
<br />:1053!' L U ~ PERMIT -'.TO x.^•F ,~;: x`04:: OI`-r r.. ry; «,..a
<br />i.k'F'LOEN? G4'i`'. 4AT.'it REQUIREMENT ~ ^. 90bA LyC !l,iTjT F'Y y;;/L M?i
<br />T"
<br />i OLIUSA $T.L~'.;-L'' SAMPLE ': C: lA *: r,:n 44;: r„-.: ..':~-+t ,` ^ I n') (/
<br />nI ~I
<br />
<br />MEASUREMENT
<br />IV I1
<br />'v
<br />1V 0 ~
<br />/„ A
<br />Jii':r`; (: () 0 PERMIT 3i=pkro %:¢~44'# O'+:- 'k #4"r.%t: npLl-T nor n~G ( ~+"c'/ r~Aa
<br />j-. .:C"'?!I*S 4RLJ`1 ~REQVIREMENT ~ 91ro`R In"'A n~V" Q:eTT.7 "!R '1L/L 17`'."..
<br />SC~i•.7~:, erTt.~:+ ,r c SAMPLE ,•.,~,k~?::{: :.r~:a.;: ::#;:::#a ~ J5)
<br />I
<br /> MEASUREMENT 6/ ~ O ~ b ~ ~~/
<br />iU~yS .. J PERMIT -: r.:.Xxffi fc :r4yn ~t ;•~:: :##>x':! RF'nn QT '^P!7nT c ^'/ 'na'.1
<br />F L U t' ~i ", u ,° : ~ - -' = L"
<br />- REQUIREMENT ~: R?'k
<br />~ODn D,*1^
<br />'.11'T.IY '!Y
<br />"L./?.
<br />1U,•w.
<br />.. ., hJ ..N F, .,
<br />r ''
<br />^O' SAMPLE :=R::~~ '`-~?r„ .^. r:.'.:
<br />~ ~ N)
<br />~/
<br />~
<br />7tJ EC;"?-
<br />, ~
<br />r MEASUAEMENT A ~ ~ fl
<br />JD '~5 U ° PERMIT :.:L ,-.~ , ~^ ,. a?:f t:z: ..! :^:>t:T yr7..' 1O ( l'1"T'1 "'4R
<br />~ .
<br />'!. 11 F,N;' -r n,; a',tq REQUIREMENT ~ ,. x~::1T '•;' "-/L J:!"^
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I DERn
<br />AM FA FV UNDER PENALn DF uw TNAT I NAVE PERSONALLr ExAMINED AND
<br />MILIAR LNiN THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> Mr INOUIRy OF THOSE INDINDUALS IMMEDIATEIr RESPON118LE FOR
<br />OBTNHING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19 ~ l ~~
<br />:~icllard Mllls TRUE
<br />ACCUMTE AND COMPLETE. I AM AWARE THAT THERE NiE
<br />~ ,
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FAIRE INFORMATION
<br />INCLUDING
<br />anager
<br />cnvironmentai ft . 97~ 87~-2772 7 27 5)8
<br />. THEPOSSIBIIITYOFFlNEANDIMPRISONMENT.SEEteU.S.C.11001AN093 BIONATURE OF PRINCIPAL EXECUTIVE
<br /> U.9.C. f tDt B. eirrle•• urW N•r mnrn• m•y IncAA• un.• w ro il0,OG0 APEA
<br />TYPED OR PRINTED rlsrmuhn.n YIIP/IAwY1M/Ir olerrw•xlenraeNrrHBywrs/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO pqy
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (HelerenCe en etrechmenfs hers!
<br />]Li'r•;RNATE IL'T" cr)^ T-~, -I''7h ;"TL='R'~I' S7LT.^, (L^^, rJ•) .n2.Y ,;~L° ?' C= ~^-P'~F 74-I1~ i,•„(,r•.~ -~nogm
<br />~LA7~F:D. ~F.. 1~.1 •: F r-: 1tiE F7i? :1'79.7?, 7F u~•)1v rtr,~jlac•. ,: T•-~ r~T ,--,.; B~ _ - ~..,.,1_I ../~ 7•
<br />~~ ` 1 y w l• r r r D' O n J T T •. T• ^ D'.^ w T ^~ V'_ C~ r, w a n k n/
<br />EPA Form 3320-1 108.951 ^Prevlous editions mey be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.1 ^ ^ ., .; ~ 7 ., n ~ ~ „.~ _ J n 1 PgGE ' OF
<br />
|