|
PERMITTEE NAME/ADDRESSp~mFrmyNa./L«mlo. I/D~.ra)
<br />NAME f; E'Y.: -.'.J-t. _~f'c"•~'
<br />ADDRESS 15A }i :; ,:1` .
<br />FACILITY
<br />LOCATIONNALil ~.', ~~) 30y j:I
<br />IT[.a: G'~J:c~; ~~CC:RiON, .y1Nc A~q.
<br />MATIOMK POLLUTANT DISCHARGE ELIMINATION SrSfEM ((NPOESJ
<br />DISCNARGE MONITORING REPORT lOMR1
<br />(7-I51 /7-19
<br />COGB5003) U03 A
<br />PERMIT NUMBER DIBCHMOE MUMBFA
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ TO ul uy
<br />(70-7/I l12-73I (11-251 116-I7/ I18-191 (363/1
<br />POND C/TRIG
<br />(SO$R 9W)
<br />P - FINAL
<br />NINDR
<br />- Form Approved.
<br />TO CAgI'A~S°A~'~f~~
<br />ApproveL e~pjl~505-3 -98
<br />"r NO DISCiiARGE ~~~ #":
<br />Y NOTE: Reed Imwetloru before eompletlnp thle tam.
<br />PARAMETER l3 Ord Onryl QUANTfTY OR LOADING !~ Ord On/yl QUANTITY OR CONCENTRATION NO FacauENCr SAMPLE
<br /> l15-531 151-5/1 !38<51 146-531 15L511 GF
<br />l37-371 EX ANALrss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Ie7-ss~ !µ5B1 159-701
<br />rtf ~ SAMPLE ~##;#x#. ... :S#-7c:~S.. ., _ _. _ #e#_ ;:;:. . ( 12) _ ...
<br /> MEASUREMENT
<br />~':.JJ I U J _ PERMIT k$Gr.#. ~-#~#x#
<br />
<br />~ ### s~,5 -w..###..# .
<br />9'.0
<br />EE!4I.X:
<br />116ITY
<br />is LU$NT ,~h'Jici YAL'J REQULREMEN7;. .~.. .. .~ .~ ~ ; ##Ot .slrti Z.tlUB ~ ~ .. :.. M)l~k:I~)!#~)M.. SU :''"' .
<br />;.~ ~~
<br />_.. ,.i US, Si;TC[:EA5 LE SAMPLE #####+`- ,`. C###.-# ###,^„# #rOr ,'1[# ( 25)
<br /> MEASUREMENT
<br />~
<br />.1J~w~ 1 U "•0 ~„.:~.AERMIT`~r`.; ~ - ?#'###.:: :~: # .:'~0~:~ #~~ .~: :~rT#~~.#~~~ :~~~~~ ~71#~KrX':.#.. ~.. 5~'. ;.;~::~;~~:
<br />:9~5
<br />: ~ ~~ :NEET
<br />~~~~ ,R¢B
<br />
<br />rc'LUI;NT GROSS YALU
<br />g,EnUIREMENT.
<br />':<e..: .:'-::.... .. .....
<br />....: ::.
<br />~x~:
<br />- :'.
<br />.' .
<br />.
<br />t
<br />UAI~Y !1
<br />l1L~L .
<br />MONTIf
<br />,.. L .,R J SAMPLE ; #f-~## r.--.: ## .-,~#;"{-'# ~S# ,f ( LEI)
<br /> MEASUREMENT
<br />
<br />).i ~ ~ 2 1 J ) "PERMIT r rg - :G:;-- '=~ -.-,. 6 r###'-k -. r##' # 20 OEITIN $~ $
<br />.r'r'LJdNT ..:'li:; 1lALU ';REOUIREMENT~ ~ ~ '. ~ ~ ~k S3AI`LI~ t1I NG/L GEIiF
<br />t LJa, ..' :1~ SAMPLE ( O.j) ',=,"-;~:;r :~ .-,.-. .,. #~ ~Y :'F
<br />_
<br />., d J T$~E , ^ -_' 4 T P
<br />L~I U MEASUREMENT -
<br />.
<br />~UOSO ~ J J
<br />y:H~ :. PERMIT )i'TI~.f1AL R5?ORr : F$L~#'~1 #,#X# # #r:?;.# a ;:## $~E/.. >i$TAtI
<br />~
<br />~EtLUEYT -;tiJiS YAL~~ OUIREMENT 3JD4 A17:, DASLY `JX l1GD :#''•# .
<br />SlON'YM
<br />i L ui1 /; ,! SAMPLE -..-.: kG ( g~) ##'v`."i-i ~~ ~. ~....- .. ;: ,"•-~,:###
<br />+f I.iJ AL ~ ~ MEASUREMENT
<br />
<br />r4u~i i] 1 0~ D ..;::~:PE.R..INISi?;. ~. . ::..t .: #?..~ $3PORT ES=1 k.^•Xt'.1~~~ >Rv=v`. "- .. #~$~'.--,"r# r,.- ..
<br />~ UA
<br />I~5 L
<br />::F.^LJdMT vRJSS YISLJ2 iHEO.UIREMENT~p :~~.~.•.~::".t,~}~.~.:,::.::_ IYS~F EItY; H~7 ~ ~ ~
<br />.. ~ ~~~.~~~ .
<br />vY ~Y
<br />r /
<br />~y,I~
<br />3iVA1.R
<br /> SAMPLE
<br />' - MEASUREMENT
<br /> .~'RER.MIT ::':: : . :~ .. .
<br /> ~REQUIREMENT~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT -
<br />NAMEfTLTLE PRINCIPAL EXECUTIVE OFFICER I cERn
<br />AM fA FV uNDEa PENALTr of uw THAT I NAVE PrnsoNALLr ExAMn/ED AND
<br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DgTE
<br /> MV INQUIRY OF THOSE IMDINOUALB IMMEDIATE
<br />Y REBPONSID
<br />E F
<br />Richard A. Munson L
<br />L
<br />OR
<br />
<br />Vice President OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB
<br />TRUE, ACCURATE AND COMRETE. I AM AWARE THAT THERE ARE
<br />SIGNIFICANT PENALTIES FOR BUBMITTINO FAIRE INFORMATION
<br />INCLUDING
<br />
<br />70 7z3-x+338
<br />
<br />QI
<br />
<br />09
<br />
<br />8
<br /> .
<br />THE P0951BIUTY OF RNE AND IMPRISONMENT. SEE le U.B.C. 1 1001 AND 7]
<br />B
<br />C
<br />1 1318
<br />lR
<br />U
<br />W
<br />N
<br />d
<br />h
<br />f
<br />d
<br />IDNATUIIE OF P111Nd L E]IEd7fNE
<br /> .
<br />.
<br />.
<br />.
<br />N
<br />F
<br />, ul
<br />r
<br />war mem, in,Y
<br />rAd,
<br />vr, yF ro S 10,000
<br />TYPED OR PRINTED w>,.I.,~,.,R YnpriaavMnrbMDrwlaRN„d„ws1..A1 OFFICER OR AUTHDRIZED ADENT coDE NUMBER YEAR MO DAV
<br />a,uMMCn IJ nnV [nrLAnn nvn yr nn. ~~.. moer enc. one mcnmenu--nosy
<br />~ETTLEAEL 3?LID; LI^.IC ~3IYEU FOR lU-[d, 24-NR pRECIP ?9EM1' SUBJECT TO BURDEN OF PROOP REQUIRElfENTS IN
<br />r'AitT I.t3.1.D, ~. ~>. ~i7t9iATEK !1ANA.;E7E9T PL-N DUR 1-1-I9,
<br />EPA Form 3320-1 108.961 Pravioue editions mey be used. (REPLACES EPp FORM T~0 WNICN MAY NOT BE UbED.) 02 77 / 97 0$19-1254 PA'T'E LOF
<br />
|