|
PERMITTEE NAME/ADDRESS pndude Facility NameJLocarian i/Di/Jerenp
<br />NAME
<br />COL44Y0 C7AL Ci)r'FA`~t', L.?.
<br />ADDRESSC. (J L04 i0 diNt:
<br />77.71 STATF HIGHWAY 13 '"`~~
<br />FACILITY P~~ LAER ~ :C.D E16g1
<br />LOCATION ~, ~;.~~,,.
<br />ATT9: J. G. HARMON, GEWF.9-4 "A1:AGFR
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCRARGE MONITORING REPORT (OMR( ,
<br />(246) (IA 9)
<br />L'/YL3OU tit r,T _,eR"l:'~l
<br />yERMIT NUMBER. ,; .'olscrinnce'NUNteER
<br />MONITORING PERIOD
<br />FROM
<br />(20-21) (22 231 - ~(1k15 ,. l26-211 (29 291 (30-711
<br />Form Approved. .
<br />OMB No. 2040-0004
<br />~~ ~'~'" Approval expires 0531-9R
<br />(cll'iR Nii)
<br />F - FIMAL !lOfAT
<br />PROSP~CS SED PD/GOOD SPRING C5
<br />~~:~yN~OTE: Read Instructions before~mpleting this form.
<br /> (3 Certl Only) QUANTITY OR LOADING /4 Card Onty) QUANTITY OR CONCENTRATION ~~ ~ N0. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) 'r (3845) (46.63) (54-61J ~ SEX ' OF TYPE
<br />/32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />r62 cal ANALr515
<br />(64-68)
<br />6970
<br />TiI L AFL ;: ae A.' E SAMPLE ry Gt~A +~' ~~ 'a l) `•?IOIIIL04 d$OttGrr 3COtr4Y-
<br />V I c.U A L. MEASUREMENT ~ '- ~ "`' s
<br />
<br />tl4U5h 1 C U -..PERMIT ~- ~'~~Vi-T~
<br />' -.a
<br />~ ~5=1 '.
<br />~
<br />4 .:~
<br />~ ~IS~6~' ~ ~>rCl~
<br />~ ~
<br />~` ~i),&t
<br />~'
<br />C?FLIi''.!IT bh;g55 YALUF REOUIREMENT= i~~""~
<br />n ~. n
<br />~
<br />~ ~
<br />'" ''1 W
<br />'
<br />~
<br />" =1Q ~"`
<br />`~ ~
<br />~
<br />' ~
<br /> 1
<br />~ -.r .W F._' S _
<br />..
<br />~ ~ -e ~
<br />sa .r,
<br />t'h ;
<br />9h .r,
<br /> SAMPLE ~ ~ "'
<br /> MEASUREMENT : .A~fy
<br /> PERMIT ~-
<br />'
<br />REQUIREMENT'
<br />~ +'~^
<br />~ ''
<br />~ '"a` ° x
<br />~
<br />.)
<br />, ~ ~:_ • -'!
<br />~,.
<br /> , , _ ~ yn
<br />x -
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ,l BERMIT - •- _- - - •r ate' ~ ,,.- , -
<br />- ~'*^
<br /> -REQUIREMENT _ -, ~~ "~ x
<br />-~, _<"~
<br /> SAMPLE
<br />~
<br />~
<br />f
<br />~
<br /> MEASUREMENT ~`~~ !
<br />.E
<br />- ~-j.- PERMIT - -
<br />~ - x~' ~x'~r ; -:
<br />` t r ~ --
<br /> REQUIREMENT -- ~ f ~{ ~ ~ ~
<br />^ 7 ,~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> • 1 -: PERMIT- . r - - -
<br />~ 7 x:-- tI `•`k' f r '_ a
<br />~
<br /> 'REQUIREMENT - - - - - "
<br />ors
<br /> SAMPLE
<br /> MEASUREMENT
<br /> .PERMIT. _ r ~,_
<br /> rREQUIREMENT -::. .- ~- .-:. .. ~. ~ ` s ~ r, ~: r
<br /> SAMPLE
<br /> MEASUREMENT
<br /> t ~ ~ PERMIT
<br />~ e g- ~ ~ ~ -
<br />- x xi. '"
<br />" . `[ ~' ibY
<br /> ~REQUIREMENT ~ ~ :`,~•+^.~ v ) ?~,Lt: ~W.. „~.~-.
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERE NALLY E%AMINED AND
<br />ON MY
<br />IN
<br />AND B
<br />E
<br />
<br />~ TELEPHONE DATE
<br />' ;
<br />AS
<br />D
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE:
<br />\~~
<br />
<br />
<br />~ ,
<br />ACCURATE AND COMPLETE 1 AM AWARE THAT THERE ARE SIGNIFlCAM
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING THE ~
<br />„~1
<br />~ ,
<br />POSSIBILm OF FINE A
<br />E n
<br />~
<br />-
<br />r1 ' , 1 y ~ t~ r ~ ~ ND IMPRISONM
<br />NT. SEE to U.S.C. 4 t00t AND 33 U.S.C. SIGNATURE OF PRINCIPAL E%ECUTIVE Jr1
<br />l ~'T • !hT ! 1 ~(~
<br />TYPED OR PRINTED mtiximum i~m~~pnmem of tbeRVee re6Niranea end Sude lines up ro 310,On0 end w
<br />p 1Tnrs)
<br />'OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAV
<br /> ODE
<br />wmMtn I s nrvu urLnrvn I lun ur nrvr vI~LA I lurvs t/tererence au e0acnments nere) ~ -
<br />Sa'C2`LP.ABLE SOLIDS L1!IT APPLIES GNLi IF G=10TR,24NH PR£CIP EYENT IS CLAI~F,A. If .CLkLIf APPROYEb 8i YOCIT,
<br />TSS ~ IROK 4IMIT5 WILL NOT BE APPLIED TO REPORTED l;EASURE'fEEtTS - SE£ I. A. Z, PG. S fdR BURDEM.dF. Pfl00P
<br />EPA Form 3320-1 (OB-95) .Previous editldns may not be used ~ ~ ` ~(R~EPLpCES EPA FORM T 90 WHICH~MAY NOT BE~USED')°.~". ~~, -:` ~ ` ~ ~ p' ~~AGE r~, OF.,
<br />.~,
<br />....
<br />~ ~ ' • ~ ..
<br />`, .~._-~,.. -.y...Y.. u ~ - ~ _..._~. .. ,. J ~ _sf~'L.`u: ~ari.;m... _ . .. ~E,p, Y , -,t'A~„;,
<br />
|