|
•'
<br />PERMITTEE NAME/ADDRESS p LL frYgNaw/Loranon pDrds.ep
<br />NAME ~; v .., i] I ." ,.. ... .. ^
<br />ADDRESS ~IT~~'.$ 1 I ~• j SCU' I+ L .~.. '.
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLVTANT DISCXMOE EUMINATON SYSTEM (NPOESI
<br />DISCHARGE MONTTORINO REPORT (OMRI
<br />17-161 l17-191
<br />....0 ~~~~-i1 (111 s
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i L J TO 'I°% ''1 "I
<br />nn.Jn m-131 !14151 /16171 lz8-29I !363/1
<br />Form Approved.
<br />a _ .. , ~„OMB.Noq 2040-0004
<br />• r ApDroveL axpir0a 0531-98
<br />A NOTE: Reed Instructions b ore a plating thu form.
<br />PARAMETER l3 Grd OnlYl QUANTITY OR LOADING !4 Grd Ontyl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE
<br /> !46531 154511 l38-451 !4653 151-511 EX µ~ TYPE
<br />/3I-371 µ
<br />yB
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Isz-ssl 154-58) 15970)
<br />N '!. SAMPLE ..-.r. G': .. ~. ..-.. =~r., •• ~ ~)
<br /> MEASUREMENT
<br />J.1 il)11 _ '! ,~, PERMIT ##+k'xXt .#.•~#ck L #'=Y h.) '."ti=.`•'L#-~ cr~~. ~ orvl-v •~A~
<br />•F'~'~.U":Y "~i5 VAL:'[ REQUIREMENT •".:GKO 1It3T!1"Sh 1'!?TT'~F:f~{ S^
<br />:CJ :.IfJ`.i+ .0"A(. SAMPLE ;=x:?kfi #S-'SR#r #9:t-rs',c ( 17)
<br />" J ~ L- ~ ;" I] -; ~/ MEASUREMENT
<br />1 ~]`i 1'J 1 7 1 PERMIT k==t?X ~. -:"-#=k:: fF+ L #vk #7fififit: 35 70 N4x'F'! ~o~~'
<br />"'F'LG°~.. ~... ..:.;,; REQUIREMENT ;:kx d4nA 0.Yr, ^*7Lv MY '~~/L pr).:«.7
<br />i;, SAMPLE ~fcla~k n#O#':.~- t. •':. ,.. ~ t q~
<br />`[• ;'! r ~ ~ ^0V ~. n MEASUREMENT
<br />1.,. t7 1 C ~ PERMIT .. .. .. -tfi#:x~lll le t. fc .",: `. k'.<-=k~:; .. 1+~ °i s'n•)aT Nqs `°/ .~ta
<br />.17iU:iIiT CR'Oi- '4LOr REQUIREMENT i,;;:1 ~~n5 ,{y•, p'yrlp .v .rr/[. M7"*'t
<br />~:: :_7 i'. cd+ POTEµT T'LL! SAMPLE ..".t :p ;:h .-.#R{+qr '$vY«-•~:~'• r iclt
<br />L ,:i C7 L V ~ C MEASUREMENT
<br />)1'14 1 0 D PERMIT ~4#OGdI a>~-{er## ;:x; glRr.,y..,..: o.,r7 rm n n7a t(R+~/ 'nj.n
<br />L'UENT GRO55 v 4LG5 REQUIREMENT ~ ~- #'!;;:3 ']nr,p ,<y,• h`. [?,Y Mg '-/T ^.p;: ;'__
<br />-ll 'O4R
<br />90TP'i?~4L(
<br />`! SAMPLE #4`R'F X': ,°-#'F ~:•,:
<br />.... - ..... ( i~1
<br />+
<br />.
<br />CISi7LVP.D MEASUREMENT
<br />]1ii.b 1 ^ ;) PERMIT - v'r:S ~k ~# ¢Or###3` L t:::k .-.^.#:`'.'cR 0.07: ^4230 Ft?;.vf ...A.I
<br />diFLUcNT ;:P'J44 4PL0 _ REQUIREMENT :k":':; 30PA Ay; DAILY !'S Y, MG/L Y,p"T7
<br />-' L RJ 'iH°!1$P SAMPLE ;rG 4'~rfi 4'i."-#kA ##.',4 !y.Ib "-'C.`4>: ~ 17~
<br /> MEASUREMENT
<br />]3~'i1 1 U U PERMIT :`S:Sk;tfi rR~.:=r:!: .^ct,:k :fitkYfi? ?`•4{:^::cn a. C1 r :1VTT'; :gyp;?
<br />:.UC?]'C n,°7..`; :'~ r "'
<br />.. REQUIREMENT (:•.•~ Iu~'" «Ay X ~. l•p'I^
<br />TlT'I':.
<br />JF. ;i ;+ ..i !:+ SAMPLE ',`-': ;:fi ...". ¢f .: pc....c>;r :!- ~ T .~
<br />-r,~jVER~~"L•` MEASUREMENT
<br />11!'3 1 ~ :? PERMIT ~..: 7c:y~ r.'-;::'s i=': ;, ',.`A :r
<br />:firr. ~.;~ pc o7 pT P,. Con.., N;f°p
<br />/ ;_f•~
<br /> , r
<br />'F LUcNT ~"~= i °0. L7E
<br />` REQUIREMENT .-. . 3?1?. R'1 n.T^ ry vY n^/T, ^!0' °-'
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF UW THAT I NAVE PERSONALLY EXAMINED AND
<br />MILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br />
<br />Richard A•]tlts MY INQUIRY OF TNOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />
<br />'I TRUE. ACCUMTE AND COMPLETE. I AM AWA11E THAT THERE ME
<br />IFICANT PENALTIES FOR SUBMITTING FUSE INFORMATION
<br />INCLUDING
<br />S
<br />970)870-?
<br />712
<br />1O
<br />1S
<br />9B
<br />anager
<br />EnvlronmentRl iY ,
<br />IGN
<br />THE POSSIBILITY OF RNE AND IMFIIISONMENT. SEE 1B U.S.C. 1 1001 AND 33 SIGN
<br />RE OF MtINCIP
<br />EXECUTIVE
<br />T .
<br /> U.S.C. 1 1710. IPMrM++ uMr dwa mrvna rrr+Y ircA.l+ 5nr+ un ro t 10,000 A
<br />AL
<br />U AREA
<br />TYPED OR PRINTED .ndwmvimm,tn+vlo++r+r c/Mw+ersmmNa+rq SFw-A/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ea attachments oars/
<br />)T :. GH':A r' rr.r, C(1C'..i"TTi ~'/+ D+ ~• 1"y l'1 1="1'~'nPI'S1; tlrT'^._ _ '-)n•\9~'- r~+ .I.....IR.,[. .]-"c~Tt~-n
<br />I' A L $ - r i 0 ... • n [' v / • I r ~ ~. V ^I I ]' ') ' I ~ 'i ;. - .:. f , a y ~ ~~ ~{ .]' I . i ~ v .. m T ~ c 1 1 O : -' A T T : 1 T. - +
<br />EPA Form 3320.1 106-951 Previous editions may ba used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.) ,1 ., `~ ; /,] „ ~,I „./ _ T ~ T ,I PAGE / OF
<br />
|