|
'[RMITT[E NAM [IADDR[!! (/nClud[
<br />'dcl7iry NdlnelLocdlbn if dlffennr/ _
<br />l .I, ..
<br />'wrrE-=-=---------- ~---
<br />1DD11[Ef___-__- ____
<br />---~--~-_-_---1 -^^ 1 ~ T~ --
<br />!Aess.srr----------- ------
<br />.OCATIOM __
<br />N ATIOM AL FO LLVTgMT OIICNARGe [LIMIry AT10M lYST[M iNPDESI
<br />D ISCNARGE MONITORING REPORT /DMRI
<br />1 /6 I7-19
<br />` /_ „_
<br />PERMIT NUMBER oncHAwcc ryv.I~u
<br />MONITORING PERIOD
<br />YEAR MO- DAY YEAR MO OAY
<br />FROM ~ •. .~ TO ~ -
<br />' /10.1n /11-131 /14151 l16~1A rz8.191 /30.3/1
<br />;,Form Approved. ,
<br />' 'OMB No. 2040-0004.
<br />' ' I Approval expires 6-30-91.
<br />~ .r '
<br />. .. .. ~ ' (/ I 1' '
<br />NOTE: Read instructions before tomple~ing this form. '
<br />' (! Cnrd Only) QUANTITY OR LOADING (1 Card Only) OU ALITY OR CONCENTRATION I
<br />PARAMETER (4e-33) (346!) (3a-iJ) (41S,fJ) (J4fi1) E% FREOOVF NCr SAMPLE
<br />TYPE
<br />(31-37) ANALVSIs
<br /> AVERAGE MA%IMUM UNR6 MINIMUM AVERAGE MA%IMUM UNITS Rlbl) (6d68) 169-111)
<br /> 6AMPLE t
<br /> MEA6UREMENT
<br />.I '. /,I:z d'BY$w~'< .a L.e".~%a ra+e
<br />~
<br />Po
<br />• .16 i":ba °.,^
<br />p ~"g°., # tae'.' :le
<br />'
<br />~
<br />~ r{•y '"'.
<br />.
<br />~ x1 A'.
<br />.
<br />.
<br />I
<br />'
<br />'
<br />' WEQUIREMEt+'f' ,&mm
<br />'
<br />amq,
<br />r<r y rL.>xcs;~&¢'
<br />s
<br />m ~e "t.Kv
<br />`q
<br />~N~
<br />'•$'
<br />k ¢'.1&a°x~tt:r aR~ °~',x
<br />'>.
<br /><..q
<br />.1
<br />fP~
<br />V
<br />' r sl`q
<br />`y ~9n
<br />.
<br />,
<br />:~_ v
<br />.:. r
<br />s
<br />as
<br />5° ~s y
<br />H.°g• y
<br />..
<br />'e j3Ja p1. 4"
<br />, xi< ID~ cq
<br />9.
<br />.
<br />4t F.. 5
<br />
<br />. 1 -
<br />
<br />HAMPLE a-;. ... ... ...-.•
<br />........
<br />::::. .....". .
<br />
<br />. .. .. MEASUREMENT
<br /> S ~~ s ."":},~,ii+i.tt•~. :.Y .1.`P,}i,~.p n$.Y'~i~r.iv C. ~' x1 E •3.-), ~r ..~. .. 8
<br />' <., ~ ., Er :i: .. 5, r., rt
<br />
<br />' r
<br />RffSU1REM HNT '. .; ~ 'c<a.e e~
<br />K < ~ ,: g
<br />~a" e ``°
<br />o . ., .'' r
<br />Y`
<br />° . q€ t
<br />~on
<br />) E
<br />i~}
<br />~ <. a ail'
<br />~tT e k7,
<br />' ~ . `
<br />~ ~~i,'cI ~~18
<br />`
<br />,
<br />! IG:.t•'
<br />..
<br />- ..
<br />YF b
<br />A.a
<br />' e: ~%
<br />`r&n Y~..'
<br />n .
<br />~II.
<br />6 ~
<br />kcHa #%... ~' . ~Y i~a.
<br />x& ~. S A§
<br />.
<br />%.
<br />'nk 4~
<br />. } I
<br />@°c (. it
<br />d' b . a
<br />' "' '" RAM PLE
<br /> MEASUREMENT
<br />1 It .. ..«sr
<br />
<br />
<br />r
<br />°
<br />' ,AA;.A~1f;::,h °.G
<br />
<br />
<br />.
<br />t$
<br />~ •4 ~~~bY .i. -.39
<br />.
<br />
<br />t
<br />C
<br />s~1
<br />
<br />~ °:Pq~: y~t~•-
<br />
<br />
<br />S-'.,sy!j'
<br />°$ Tp ..r..ffi :,.. r...Yn
<br />
<br />
<br />"'
<br />B•:
<br />•b•:
<br />a
<br />n/.b°`iq.'
<br />~ R
<br />°
<br />M Y .yl L. .., ).r ,l~~"•'..
<br />l~ :. ..
<br />,
<br />•- 1. PERMITS
<br />8
<br />RSOUIItEM ENT a~
<br />.8p °"
<br />e.°
<br />""'xnn °fla:y .
<br />.,
<br />.,°
<br />~t•~wea «:R~~
<br />..- q
<br />°m
<br />„t,~"~n s.~a .
<br />'a'*a; .°
<br />, ~
<br />i.
<br />-ay'
<br />'
<br />~~
<br />`
<br />'E'
<br />~
<br />~f ...
<br />'z:5"'
<br />„
<br />11
<br />.I ~ . x
<br />e
<br />i
<br />r
<br />'
<br />ss
<br />..~ r r ~ 'J1 SAMPLE ( i~ .. -
<br />
<br />
<br />' ~
<br />., .. .~ .~ I~..r_ t'i. =..
<br />MEASUREMENT
<br />
<br />'
<br />ws"PERAi1T
<br />sF ~,F~x~'}!~v'¢..,
<br />e,L S
<br />.~~x
<br />~=. ~. A
<br />?'x,~~%t l`<... 8''. ". g:;:'µ 'se': -'~.•1
<br />'~~. '"`~a. "yep ,.a x
<br />.r,i~ m'I,,;f
<br />I
<br />, °REgU1REN$NT: .
<br />" ;p F~ ~a ~°
<br />' ,
<br />s
<br />g., 7°q.;w •'s^'a
<br />~
<br />~ e ny
<br />^ ; zap;@aa., 'use
<br />~
<br />,
<br />/1:.:i
<br />'1~
<br />Po ,
<br />.3iia:,ng~ .~F~(s'.:° >u~, ,:3 as
<br />s~e= ~s
<br />>r .
<br />~'I.
<br />i r s1%.. I `~~
<br />. r
<br />.
<br />, eAMPLE
<br />r MEA[UREMENT
<br />' A
<br />e ``'rm'Sng•s:
<br />, "`y,' d!-'~'.'. Lrq :. e". '.: it2;t:it :.!e}x'S,p ',~1,.'":s5..a
<br />.
<br />,e~` 3: wp
<br />"+'"e s~:p
<br />p ° .i'x t*`r„ ~-n ~f ..
<br /> ERMiT
<br />•.
<br />REOUIR EM ENT n
<br />°
<br />„e ° .°.e.e: ' a.a -°, ' >~.. ,:°` a
<br />. ir
<br />~
<br />°x .
<br />a
<br />.. K.~.e.,''
<br />; °
<br />Y
<br />'
<br />s
<br />` ~
<br />nee ,,t
<br />'
<br />®'
<br />~
<br />~
<br />~
<br />-
<br />~ ~~
<br />
<br />.- : -
<br />.. . ...
<br />~ ' '
<br />.
<br />°
<br />•s. a. `
<br />.. aa rec. •ree
<br />
<br />a
<br />x... .., ... < as
<br />
<br />
<br />
<br />"• c ,...
<br />.., .. r s,~
<br />~
<br />.
<br />
<br />
<br />,.. ,<., m
<br />a,
<br />}
<br />4-. .. c
<br />
<br />w u
<br />)
<br />.~,
<br />.
<br />T
<br />, ~
<br />'
<br />
<br />' ""' SAMPLE
<br />-
<br />.. .. MEASUREMENT
<br />
<br />) -ors ...
<br />'! o< :
<br />y,'...a:. v;, a.,
<br />sz Ate`,''
<br />."-
<br />. '>~-, :.,
<br />°
<br />dl . j
<br />~ a ~m:°s~n~1 :':: : ': ':A .>•
<br />
<br /><°
<br />~
<br />N , a °,:e;.;:~m'~:.
<br />
<br />~ .. .. ~., s.L.,
<br />.
<br />.
<br />`
<br />
<br />.
<br />'.~. ;>°~'"
<br />..-.
<br />~ ~, c, PERM:
<br />RCOUIRE
<br />M tNT ,
<br />e
<br />r
<br />x
<br />.,poi 's,.
<br />r„x ~ i
<br />a
<br />~?.,.e ~~ '
<br />x,~
<br />`` , F
<br />~ ~~ ~~
<br />~~~~ ,.
<br />~.
<br />~" Y
<br />~f 9C!`'
<br />° pL
<br />$~ p
<br />~
<br />}~ 5
<br />^. ). '~ )
<br />,
<br />~ ~ i
<br />ff « ~ $
<br />. .. _ k $
<br />~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> •
<br />M ~ y"
<br />~ "°~
<br />`n i
<br />~ ~•~,k `g
<br />.,~<¢+.e ~~e-x~y`, I' .m~° z., '~'z ..s^ n
<br />~ .,. q
<br /> BN.T
<br />.R000IFE e
<br />'
<br />a
<br />•~
<br />~ p
<br />,
<br />xs~
<br />'$~ ar°~
<br />°ax °•a
<br />&xL
<br />e'a. ~, e '>.
<br /> h. ~~.. .n
<br />R;;.r
<br />'e'e°d ~m
<br />k,~e a.. e.k
<br />ga
<br />d. , i
<br />"
<br />S `
<br />NAME/TITLE PRINCIPAL E%ED,UTIVE OFFICER I CERTIFr uryDER PENALTY OF LAw THAT I ryAVE vEg50HALLr [%wMINED
<br />AN
<br />MI
<br />IAR 'MT
<br />THE INFORMATION SVBMITT[D HEREIN
<br />ANO BASED
<br />/~ TELEPHONE D A T E
<br />
<br />?
<br />/ /I ~ 1 ~
<br />/
<br />/
<br />J
<br />S.•
<br />~ !R /~ %
<br />', .
<br />D LM FA
<br />L
<br />H
<br />ON MY INIXIIPY OF THOSE INDIVIDUALS IMMCdATELY gE$PONSIBLE FpI
<br />OBTAIHWG THE MFbiMATO`l
<br />I BELIEVE THE SUBWTTED INFORMATION ~ ~ ~~
<br />D ' I / _~
<br />`
<br />/
<br />~
<br />
<br />1
<br />_ ! f rJ
<br />`
<br />~
<br />J
<br />,
<br />I
<br />.
<br />6 TRUE ACCVRATE AND COMPLETE I AM AWARE THAT TNCRE AR[ SIG
<br />/
<br />/
<br />~
<br />~ '
<br />,
<br />'
<br /> N6ICAHT PENALTIES FOP SUBMITTING FALSC INFORMATION INCLUDING /
<br />'
<br />/ "" 'f~
<br />~
<br />~ •Sl /~
<br /> TnC POSSIBILITY Oi FME AND IMPP50NMENT SCC IR USC f IOOI AND 1
<br />-/ n 'i 1
<br />' /^>"•'r .O
<br />I i r undr. rhr.r uarulr. n nrldr /
<br />]]u5C t 1]19 rP
<br />n
<br />o• Jlu nu
<br />ra
<br />hi SIGNATURE OF PRINCIPAL E%ECUTIVE O /r~~,.:- / (.T /
<br />
<br />/ TYPED OR PRINTED r.
<br />,
<br />.. uy
<br />ma
<br />y .
<br />o•d... mnnm~m lmynrulmrnr.•l Mmr.nRm•mrh.and i.n..I
<br />OFFICER OR AUTHORIZED AGENT
<br />~ A
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />
<br />:OM MENT AND E%PLANATION OF ANY VIOLATIONS' (Rr/rrmrr all attacnmrnls nrrr)
<br />:PA Form 3320.1 (Rw. 9'EB) PreNoua editions maybe used. IR[PLACE! [Pw roRM r-.o WHICH MAY Nor a[ us[D.I PAGe DF
<br />
|