|
PERMITTEE NAME/ADDRESS p.3,mFdiryNarlaemran Unrgnrn0 NATIONAL POLLUTANT DISCNMOE ELIMINATON •YBTEM /NPDESI
<br />NAME
<br />~
<br />E i
<br />.J
<br />KE 1 -
<br />r•C DISCHARGE MONITORING REPORT IOMRI
<br /> . .• • , 1-I5 17-191
<br />ADDRESS 4 f,.~ ~ L r, >7 i •: E "'' ') F 7( 7
<br /> - d . I N
<br />R
<br /> 1311 ~¢w
<br />t Wor Dr
<br />/c PERM
<br />T NUMBER DISCHMGE
<br />UMBE
<br /> v
<br />Fr±-rt'~r ;
<br />~ v .~ ., s l l ~ r"~- +ri-~^rt- r u 47111
<br /> MO $ERIOD
<br />FACILITY
<br />" '- • N¢w
<br />- 61k" Ml:na YEAq MO D. ~ YEAR MO DAY
<br />LOCATION .N ; ~ r'1'I A k, (~A rr C r) FS 1 J 91 FROM 1
<br />E TT'i .. _ r r u r u 1 f r^ o_ nnen b2noi rf~ rfR1A UN-191 134311
<br />Form Approved. E
<br />' ;+':.•) ° ~ .' I. r 7 / P 11 .CIv~lyq.I2R40"OQG'6 .. .,
<br />n /, ApprovM • ,0~-3t-98
<br />1
<br />- PINAT, E
<br />rIRON
<br />QQP, 'JIG DISCHARGE •%"•.
<br />NOS: R••d Irntlvetlarr bdor• complnlnp fil• form.
<br />PARAMETER l3 Grd only QUANTITY OR LOAOINSe !1 Grd onlvl QUANTRY OR CON "TION NQ. FREOUENCr SAMPLE
<br />
<br />31
<br />37 (46-53 51-611 l38-151 15-53 f6L611
<br />~
<br />EX OF
<br />ursls
<br />N
<br />TYPE
<br />-
<br />/
<br />l AVERAGE MAXIMUM UN175 MINIMUM AVERAGE MAXIMUM . UNITS rz-rn r
<br />A
<br />/61-65) 163701
<br />F~F{ SAMPLE '<C C?bC PGS O:cG FY#'t tcQ ( 12)
<br /> MEASUREMENT
<br />
<br />004U7 1 0 ~
<br />.. .PERMIT ~~:~
<br />:~~~ R4#O:R4.~"
<br />~
<br />?<::.~!klSO~fQ~4~ ~~
<br />trGtr
<br />:~~~~;::~.:.: ~:. ,...... .
<br />afiXrf..l~(~"
<br />:.:~1*n ~
<br />.:
<br />..E~PrL~.
<br />Z31STT!
<br />.1
<br />:,F"rLll'`I ': ..KISS VA[. RECUIREMENT~
<br />~~~: ~...: .:~ ~ ~ :: ..:.:..,.:~~,
<br />..~;. ~'~::..' :.::: :..:..:.
<br />:::::... ~
<br />QG44
<br />..:..~~~ ~
<br />.:~tS A Hl;~..:
<br />S11
<br />
<br />~.:.:
<br />;, ")i.I D:?r '.'OT:gL SAMPLE GGQ:xR ,,^•.^cGC^3 q}~14 .R^- ( la1
<br />51f'~f'vy1J ,•;~ MEASUREMENT r:
<br />~
<br />U11',.4'J 1 U D ;PERMIT ~ . . C~YSRRTF ~ 'XCRAr9G~ ~ Rt:.:` '»~~
<br />~ ... .
<br />.. F'r L+J Y!1 ," ;R75ti Y!!LtJ 'REQUIREMENT ~. ~ ~ a.^,.:~ ~
<br />...
<br />~ °~~~p:Gp :~aYr.. ~. tfAl~. .i ~?S~x 11G ~ !ONT.
<br />„I LT II :;• ,;:TTLPR!+[,c SAMPLE `R R". r, .^ ',e'%::45^. ^I!'4OOQ ~ 'GC¢iS#'= ( ?§~
<br /> MEASUREMENT
<br />U'.)5'1 `. 1 U U ~~ ~PEFIMIT ~ ~ OG'bc4~;x.~.. .'~~. '"•O9eQlY it R^^ 3?X+R:.~,%~~ y~,~.::-~~:A1lp1IER.~: .. ~ ..tJ~..:
<br />. ~~ ~.tiCf?~ %~RRP
<br />~F'r'Llf°.>:T 'iRUSti VAI,'J .REQUIREMENT ~ ~ .;;~ : ~-:>,: .: .'.~.:.`T:. ~ /L A}n#('1'
<br />1FJ\• i7':AL SAMPLE .rCt=~ a.ca-^' Gi ( t0)
<br />(S ~ P ., 1 MEASUREMENT
<br />"7.vIS [ 0 ;1 PERMIT ~;aaxG GV~L<C'x G^" FS+XIfSA`~:t: ..:M+~. '7.;,0 H'•r/ "9.4i'
<br />F1.11="I !' ~iR~7S'i VItL!F REQUIREMENT p-x:r, ~.~ A%~~~.~YG
<br />~ ~ ~:~~ Il ~~~~T l'!7( ~:':/L el~lYT.
<br />%Il. A!;li :iiF.ASA' SAMPLE '.... :c •3reG:t GR>x>QC ?CQ4Y':+ ~ 19)
<br /> MEASUREMENT
<br />:` S-> : ? 1 0 " ~::PERMII~~
<br />: G¢Erttn~C ~ F~Q~~Sc~F=k .
<br />~ : ~aG-:` ~ 5~~~tE~'A''r:: ...;;<:.:.:...'Ek.,!~~:;, ::~;~'.:':"..~...::..
<br />~~~ ~,C!$TT. :P.A?
<br />
<br />"'L'J`.+f :R~+~ VPL!1 ..
<br />,
<br />:
<br />..
<br />~IfEQl11REMENT
<br />~~ ~ ~~ ~ .
<br />..
<br />:~:. ~
<br />
<br />
<br />...,fi
<br />,,,
<br />~ ..
<br />
<br />
<br />"`?:.;",':'i;::;;:'{.t;
<br />~ ~ .
<br />
<br />.:,.....
<br />:::::'~`:7V',~'~':::!!`k1[
<br />
<br />
<br />G/L
<br />
<br />
<br />INT
<br />;~L.i-1• I! !'D'IU'Ilf "1 '1 SAMPLE ( Il)) .S~~C+f ?^Ofi:G t,: t'-#;k:t`-
<br />"' ,i ;,' ~ T c'. c g T• r p r ~ (, A y EASUREMENT
<br />'~'Y~?'.'J 9 7 ~: PEHIYIIT...: .;. £P~~Rt~~"a :::.::.::~R~~pA~A~T xt(Or ..4F:# ~~ : ~. rxR~ ... .:'~'•'4:L¢J^:yr~. ~ .r.,.~ .. ~ *''B~L Tfl i"A
<br />'.F'PL'Ji.•:Y :; P,lSS YAL'1 :REQUIREMENT' .3O.OA~~~d~1t~~' ~~~:-OA~tiiS..RK~ "/:~ : :+.~ ~ ~ 3OG;~
<br />;iC SY~ ;~:; F.AS°: SAMPLE $:G?IKG ( 941 it-.^•. +.ISR4-.# . . ..,-
<br />y I S ~ .t (. MEASUREMENT
<br />,:JDS', 1 0 !1 : ~ P,ERMIT:~ :~
<br />~.. :.. . ~~ ~ .Q ~.:.': :-~:.~ Y'~QB. ~ !': :;=1 'GC%P' .. ~ 4~ : .n
<br />~~~ . ,
<br />~
<br />f
<br />. ... p,
<br />
<br />i FFL;I >. :~~
<br />T ,:R"1S ~i VsLU .
<br />REMENT.
<br />FIEQIl
<br />I
<br />:.ai`<
<br />~
<br />~~
<br />~
<br />~
<br />~~
<br />:::;~.M j.:1'
<br />A~
<br />~
<br />:
<br />Rn=O
<br />~ ~ ~
<br />~
<br />x...c
<br />¢;
<br />. :
<br />. .
<br />.
<br />.
<br />:
<br />.
<br />..: .
<br />.
<br />:.
<br />:
<br />NAME/TRLE PRINCIPAL EXECUTIVE OFFlCER I CERTIFY UNDER PENILLTY OF L AW THAT 1 HAVE PERSO N
<br />ED AND
<br />NALLY EXAMI
<br />D TELEPHONE DATE
<br />
<br />A - L d 1 ~ `I A
<br />5
<br />FOR
<br />Mr FINOUIM OFHTHOSE MDIVI~Uµ9 MMIED ATE rE1REBPONSIBLE
<br />1 BELEUE THE SUBI1~AITTEO INFORMATION Is
<br />GRINNING THE INFORMATION u
<br />' / U Q
<br /> ,
<br />1 AM AWARE THAT THERE A11E
<br />TRUE
<br />ACCUMYE AND COMPU~TTE /f••~t~
<br />/~( '\
<br />
<br />.
<br />,
<br />F011MATON
<br />INCLUDING
<br />R
<br />I
<br />M
<br />F
<br />.
<br />(jl^
<br />~i~ c G
<br />
<br />N~ v..~ N G *
<br />,
<br />SIGNIFICANT PENALTIES FO
<br />SUB
<br />AITT
<br />O
<br />ALSE IN
<br />) ~~,- Z
<br />~]] L 1 ~ b U G a
<br /> THE POSSIBILITY OF RNE AND IMPiP90NMENT. SEE 1• U.S.C. 1 1001 AND 3] ~
<br />R
<br />
<br />
<br />TYPED OR PRINTED
<br />U.S.C. 1 1311. 1PnWtlr• ~Kw Mr 01n1•• nwE ncA/A• hra W ro ! 10,000
<br />womA.Hwan >rrwi•orFrom eibMwrrmm•u rtlbr•ral AL EXECUi7vE
<br />NENATURE OF M11Nd
<br />OFFICER OR AUTHORRED AOENi
<br />
<br />CODE NUMBER
<br />
<br />YEAR
<br />
<br />MO
<br />
<br />DAV
<br />Cvmmen 1 s Anu ewrLnnn I wn ~r nm vwLn I was rrt•r•rmc• sn •rr•cnmenrs n•i•1
<br />v1 ',?'! =.V :PF^. 'S 'ii.: -". i., .. ~q~f'rLT AY S. .. r..l ..._ ~.: I~i.,,i ~°'nr)I•"'°f. '?'1. ^r'FA ~'~ - ~'-.: 1..°.1. D~ ~. ". ~. '
<br />T~1f'•i, f''1'~; 1. T.°*,"; ~7*LI. ~. ply"`1• A1TD :°1"'l.'L~cL? ~'i1I~° (.T'rT°. 9.vnt1ri ~~" <=1QTR,24HR .,tFr(-ice ;...l~nm_•;r.•'T.
<br />r 11 1° 1 T 1r^ ~ji r rlt ~eTV•'n P lu ~I nrp 7nRV >v rLp pV~T ~~•• of r t - T^~ia'IUnF'u nF• DnnnP pr•~+'H*^-i a ~ s~~-7
<br />EPA Form 3320.1 108-951 Previous •diliona mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 000 5µJ 961213121.1 PAGE ~F
<br />
|