|
PERMITTEE NAME/ADDRESS p+ere. FsWry Na./rcearlen IrDiQ\raP
<br />NAME :i k:Y~. ~:R i, J•~L. ,: ~.;y LACY
<br />ADDRESS (~ R A. L h a
<br />dAYUr:H
<br />~~.; oii.39
<br />FACILITY
<br />LOCATION FI A Y U d'.i CO d 16 3 ~~
<br />air:,: c. euo ehouN, p61t$aAL .MAN AGE: F.
<br />NATIONAL POIIUTMT DISCHMOE ELIMINATION SYSTEM (NPOESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />y-15I f7-791
<br />CD DD( L21 QQ A
<br />PERMIT NUMBER DISCHMGENUMBER
<br />MONITORING.P IOD
<br />EAR MO DAY YEAR MO DAV
<br />FROM Ll ;TO y ~ =-
<br />naan nazv, n !16171 118-191 l3a3fl
<br />Form Approved.
<br />" 1` C 4 A f ~~ .` : O G H A S~f"IB No:Z20po 0004 ,
<br />~, G ~ [ , ~,) ApProvelLeip~r~ ~OS-31-98
<br />F - F:LeL '
<br />MT `. (,U
<br />. , LC `1r SCtiA ~.GF. ~__~ 910 ;r
<br />'NOTE: Reed inetnretioro before completin0 this form.
<br />PARAMETER 13~Grd only! QUANTITY OR LOADING G.d OnNI QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br />
<br />!1653/ l5L51/
<br />!38-351 !46531 1545//
<br />EX OF
<br />TYPE
<br />I33-371 MALY513
<br /> ~~~AVERAGE MAXIMUM U MINIMUM AVERAGE MAXIMUM UNITS (62691 /84-riel 159-7a1
<br /> SAMPLE
<br />MEASUREMENT #0 9104 F{: ,k ;+'. ~ ~ ~
<br />~ ,.: ~.»fi:
<br />~ ~//
<br />O ~ ( 1 2)
<br />~ ' `
<br />i h~
<br />UUuJ0 1 0 0 PERMIT atis391....>q~. ~»>r#;~DL.., u;;= ~,G ~'~:»»~. 5.C 'E'~KLY (~I5I?
<br />tFFLUh NT SROSS YALU. REQUIREMENT .:~:S
<br />~ : j '~ q~4;f v ~rr~ \tl!lu ~:)
<br />r0 S, .OTA SAMPLE -:`{r >k O
<br />II 'JO:~,p#tp . _{; / 19
<br />( ) ti
<br />~
<br />~
<br />'
<br />;; U,. 4'BN DEi, MEASUREMENT C' (Q - ~~. ~j„y
<br />UU~)U 1 0 0 PERMIT -. -. :~:;,#4101 Cc 0C~0:.`%' '4 7C 1kCF/ ;RAn
<br />
<br />Y.FFLUEIri vkOSS YA1.CI
<br />REQUIREMENT
<br />~ ,a~ ,. ?CCi 6Y~
<br />u
<br />LAILY %
<br />w~
<br />/:. MUI±TN
<br />J~ ~.: ~. SAMPLE .. "r:;: »+0 +7;0r
<br />L~
<br />~ O
<br />! (
<br />~ O `
<br />( ~)
<br />O ~ /
<br />G
<br />~
<br /> MEASUREMENT a ~ 3 U `+~
<br />e
<br />Cti~4~ 1 0 0 PERMIT ef::~%;=::: :`<xi::}~ ; :::ct {%n >Om RfFCgT RF..F~OAT . ItFCi./ ;P.Af3
<br />nF?ill ::;i: GROSS 7ALU. REQUIREMENT ::~;+ COCA AVr
<br />+ zAT~IY !lX "L/L dl'UtiT;t
<br />KJh, J SAMPLE
<br />MENT
<br />E .. .:;:,; ~: r: r: n:::::j .^..n4,7 ~
<br />•-
<br />'•~i !
<br />( ''^^
<br />V• ~ I ( 19)
<br />(~
<br />~
<br />~
<br />(AS pE) ASURE
<br />M - V )~„
<br />U1J4S 1 U U PERMIT ?;'~~ . . < <'+`%:< +~'+ .. ~.S 7.0 rNCE/ ;$A13
<br />tFFLUh4't' CROSS YALU REQUIREMENT ,.. ?CCA AVr, f.
<br />AIlY FlX rIG/L IIUR TFi
<br />J .. n u E SE SAMPLE ':. i7 ;:::: ~ r ... .. {~ {',+:., ` ( +~,)
<br />
<br />MEASUREMENT IV ~
<br />- -
<br />C3UUl 1 0 U PERMIT ~--'~'f 0'^% ~~~~~~ v. r`O'~~' yr,. r.Gr,.# 1.C '0!FTI?f ;BALI
<br />cFFLUF:NT G&03S Y{l,U' .REQUIREMENT ,:, Ig51 .'AX ",G/L t;EAT
<br />F Jw, N C U
<br />' SAMPLE ~ f
<br />~
<br />I ~
<br />~ ? c ?
<br />CJ•
<br />J 1
<br />6 ( GJ) ~''^';~, y:,°~°%Y1'~ ..,.
<br />O
<br />I
<br />`
<br />Chr:J TiEA
<br />C:'.£NT PLAN MEASUREMENT ,
<br />J .
<br />J h
<br />J
<br />50~5U 1 G 0 PERMIT &FPO%iT F:ZPOfi2 -'•"•»=' s:, r,co:* a»YZ:t<# :,~:t~, gEK.j.Y NSTAA
<br />EFF'iUE~•C L;ROSS YALU REQUIREMENT ]QUA AYG UAILY ~X MCi '++~{'%
<br />SU 1 ) , U SAMPLE .. .': {:: {:7:-;: {, :: ..t:: `.
<br />? '
<br />O
<br />~ Z f ~ 19
<br />( /,
<br />U
<br />/7
<br />~
<br />LiSSULJ36 MEASUREMENT O jQ ~
<br />/U,;'~~ 1 U D PERMIT +L ~''{` -~" 4Y.+^kt* Cf'IICKAL EFFORT TRLY :?Afj
<br />tFF'L'J2i1T GROSS YALU REQUIREMENT r:>:+~. ~FTF avr,_., GAILY "IX FiG/L
<br />I
<br />NAMERFELE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONULY EXAMI
<br />FOR
<br />ON S
<br />TTED HEREIN
<br />MD B
<br />T
<br />T
<br />T
<br />BM NED MD
<br />TELEPHONE
<br />ASED ON
<br />~ DATE
<br />~~•~`•••
<br />Q ~ ~. I S
<br />Q h'Q S ;
<br />AM FAMIUM WI
<br />H
<br />HE IN
<br />MA
<br />I
<br />U
<br />I
<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS ~
<br />•~ I AM AWARE THAT THERE ME
<br />TRUE
<br />ACCUMTE AND COMPLETE ~
<br />~
<br />(
<br /> .
<br />,
<br />T
<br />SE INF
<br />MATION
<br />INCLUDING ~
<br />~
<br />^.,~
<br />w
<br />l
<br />~
<br />( ,/
<br />/`~
<br />~ ( C II
<br />N x{ G V O \ V ~~ t ~ ~ ,
<br />SIGNIRCMT PENALTIES FOR SUBMIT
<br />ING FAL
<br />OR
<br />THE PO551e1LITY OF flNE MD IMPRISONMENT. SEE 18 U.S.C. \ 1001 MD ]] '
<br />Y
<br />1 L. 1
<br />I
<br />,A .~ y,
<br />V '
<br />li
<br /> U.S.C. f t]te. 1/MWI., uiw n'rr mnm. nrr Y,ch•e. u.,., w m +IO,Opp SIGNATURE OF PAIN AL EXECUfNE AREA
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />V
<br />TYPED YR PRINTED e,e a~nMrNn.n ins.:ernw,r orMww,eno,m. Ar,d6 y..n1 OFFlCER OR ALIT RIZED AOENT~ CODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRderence s// stteehmenrs here!
<br />:SJ L 1.KON LIrI1'S IrILL .: r: Yn1VEU f SETTLE,tf-~LF. SOLZCS Li".I" APFLIEC FCF <=lOYT~,2UNR PR.ECIP FYF.'(T; ':3E,
<br />I k,ih b S::CTLE'AP.LE :,OLIu:, Li:11 ~'S +AIVEU YO3 >i0Y9, 2U9 F: PR?^IF FVlNZ SUF.]ECT TC ?CRf,~V OF PROOF Z!i I.A.2.
<br />' Ti f' R lSF-SF'F' T 1 fl TD:' MnN iTrl r+T Y+' T u 1 C
<br />EPA Form 3320-1 108-951 Previous editions meY be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.! 0 0 0 0 5 / 9 7 ] 0 31-1513 PAGE 1 OF
<br />
|