|
PERMITTEE NAME/ADDRESS R.~.F«YIryN../toranm UD~i...p
<br />NAME dJNIC: d„iJ;l!+'_], LI'SIrP~3
<br />ADDRESS H J w j f. 'v J. ? 9[ v F;
<br />k'•'J• I'JIf 4 i.j
<br />Y6J.IiA ~~ SI711
<br />FAalrrv L 9 I r F: D
<br />LOCATION
<br />:1T;1~: ;iLLIAM A. j-'iR- V. ~_/~~: a3 P9;
<br />s
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM /NPDESI
<br />DISCHARGE MONITORING REPORT (OMRI
<br />13-161 17-191
<br />'l^tih .177
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM y ~; 01 J L TO J c J J
<br />!36311 l33-331 134-151 136371 !IB-191 !363/1
<br />Form Approved.
<br />MB No $f140-Q(y04
<br />'' 'Approval~Fekp]lre~'05Y3t1-98 /1
<br />f - i IAAi.
<br />S"G.t
<br />.NOTE: dud Initruction• ~•ior~ compl•tin8 thi• form.
<br />PARAMETER !3 Grd On/YI QUANTITY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> !46531 154-61 l38-451 !46531 /54-611 GF ,
<br />!33.371 EX
<br />ANALVSIs (yPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is3-sal !sd-fig! 169-701
<br />t' d SAMPLE , . ,.... r ~ r r :' a ,... ~ 1 ' )
<br /> MEASUREMENT
<br />UU9J0 1 :} J PERMIT .., ..;:; :k ~; Rte` ,-. i.S ru~~# ~,
<br />- • ~
<br />F. $ K L Y
<br />Y $ T P .
<br />F:FFLJr:1." .+~' VA' c
<br />, REQUIREMENT / T fn rr.v q+:w
<br />SUL10~, IiAL SAMPLE .a~,x x?r ,r. .., .. ( 1')) •
<br />ii U [i I' '~ N i1 :. J MEASUREMENT
<br />U05±U l J J PERMIT rt.y0'YR k:#s#;: ~. SO:=PrT
<br />J~
<br />7
<br />}NC@(
<br />>FA~i
<br />EFFi.Ut:N: ~nJ55 VAL Jh REQUIREMENT f t
<br />:iJLI US, .. ..: :'Lr,q .: L.; SAMPLE .. ~.., .~:<;: . .':: C3;; :;: r:x ( ~~)
<br /> MEASUREMENT
<br />,/)~45 I U J PERMIT 'r.^3k~Y ~:t.;;~:~ .. k3rF.~# iit'G ?' {;. `, M.:E~ ~?4R
<br />,r FLU EN'<""' :,R7S5 IIAI,J: ~REQUIREMENT .k F ~ ,~__! ,,Y ar
<br />/
<br />M'~
<br />Id~.VF TU:.4L SAMPLE ,..r. S:~:k.p:p:k ,., ," }
<br />
<br />(A F,L)
<br />MEASUREMENT (
<br />)
<br />'2:115 1 (} .} PERMIT *:: k~xk ^7~xY. ~ .. r~k: r.~-, 3.J rl r
<br />V E/
<br />~ +: A
<br />
<br />T:F:'LUENT ~n7:7 iA!.'; REQUIREMENT
<br />:rn..
<br />r,a+ ,+v
<br />h t
<br />n•~ ~n ..
<br />JIL AND ,rn EA;° SAMPLE ,,, ~. ,,. .. ~, . . r. ~, .. .. i ,.)
<br /> MEASUREMENT '
<br />:J J.7 ~Jl 1 U J PERMIT 7YS7ra ;: ~.^.?7S~ ..
<br />"'~ :,'.::-,.
<br />..r~b:'r ....
<br />'..,,.,.:x
<br />t 0
<br />~
<br />:I79TIN
<br />.3A"i
<br />r,k'FLUEn'f :,RJSS V4LU REQUIREMENT #'=;k n Tv w r.~:T•
<br />`'LJd, IN ::JNDJIr 7R SAMPLE ( 031 x~YY'::~ ... .. 5:::;,i;~:.k
<br />+ao rR~.:rrsvr PLAN MEASUREMENT
<br />7JUSU 1 D U PERMIT RF...PU'iC REP^URT S~k;RG+`::: ;;: CF'-.+' # {xL:::v::# ':.`•L:
<br />~Pr.cLY ~a•.
<br />N
<br />^
<br />t.`'FLUtF'i ~RJiS VAL'Jr REQUIREMENT j. U V„ ~
<br />., -'
<br />$ULIUS, TJI'.4[. SAMPLE ~;;R-~::i Y,-,.-.. ~,.,,...
<br />' (
<br />~~./)
<br />C .[ 5 .i J L V :: J MEASUREMENT ll
<br />~ ~ ~ ~
<br />7J1~5 I i) J PERMIT it;:A i~k .: {:#;LRFG >r`:'x :','FCtt :}:~ tTEPU 'r E7PTIOt.AL r2LY :R9Fi
<br />cFFLUEhP JliJ, 74LU': REQUIREMENT v1~ U yr N ,~-/~
<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY El(AMINED AND
<br />MfUM N1TH THE INFORMATION SUBMITTED HEREIN; AND BASED ON P
<br />/ /' /; TELEPHONE DATE
<br /> ~.
<br />/ /
<br />I _
<br />!. I. t L ~ 1 E bl R
<br />~ V1 MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNMING 7HF INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS
<br />T
<br />UE
<br />A
<br />CU
<br />T
<br />D
<br />P
<br />T ,~• ~: ;~
<br />
<br />' /
<br />~
<br /> R
<br />,
<br />C
<br />RA
<br />E M
<br />COM
<br />E. I AM AWME THAT THERE ME
<br />LE
<br />SIGNIFCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLWING ~
<br />-
<br />`
<br />1 ~ : I V ' N ~ ,
<br />THE POSSIBILITY OF RME MD IMPr1160NMFNT
<br />SEE 18 U
<br />S
<br />C
<br />f 1001 AND as ~ ~T;
<br />•
<br />'~ ~
<br />' ~
<br />
<br />- .
<br />.
<br />.
<br />.
<br />V
<br />S
<br />C
<br />1~ata
<br />/a,
<br />Ni• MNYr dM
<br />f
<br />m
<br />n
<br />ro t x0
<br />0
<br />~~
<br />BIONATURE OF PRINGPAI EXECUTNE ?~/ .
<br />,
<br />.~ ~ /T ~
<br />1
<br />OR PRINTE
<br />E .
<br />.
<br />.
<br />.
<br />,r, ~
<br />M
<br />Ar
<br />lv
<br />, nMY
<br />,
<br />00
<br />•
<br />TYP
<br />D
<br />D rd«muA.wn in«lonwN a/O.M•,n enlmN, r,d6Y•.'>1 OFFICEp OR AUTNOp13ED ADENT C~ NUMBER YEAR MO DAY
<br />~? COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/er•ncs sll sttschments here/
<br />~~'SGYiLE'b.._, iJLi'7;i LC~T' nP?LSF.J JtiLY IF := 1.}-Y~t,
<br />!B~ r,~CD, :55 E IR7~' LI7IrS GILL NJf ~i: A~PLI7 "'J
<br />P •-~- • N- w E a
<br />24-,•: ?Rt,;L. ..aENI i'~ ::L41' '.
<br />Rea:7ara~ :Io~.,,,:L::f1s.n~s -: :. .:~.
<br />1 T-0O WNICN MAY NOT 8E USED.!
<br />/ .~
<br />_' 1. afPR~PC-
<br />I ~ L c. ).7, F.;.
<br />PAGE OF
<br />t
<br />
|