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PERMITgE NAME/ADDRESS A.w.F.~wyNro./L.r.nw lJDlpr.ep - _ -- <br />__._NAME R~1 LvAt-~.._.-,_ <br />ADDRESS HOADSIDE ?!INS, N L' ~ PORTALS <br />P.O• HOI 130 <br />PALI~ADB CO Fi152G <br />FACILITY <br />LOCATION <br />dTT37 JCriN A. :1CkAF!_ ni.s.•:TnIFUT <br />_- ~ fi0 MO <br />'SIS <br />i I 0114-^lSEER~7 MUtJF'~ <br />lDM <br />I G <br />PORt <br />/ - ~'~=-~"~-_ - <br />_ ~oEI1lV1PPIOYav. - .__ <br />N M <br />r . <br />. <br />9 <br />- ~ ~ ~ -p004 _ _ <br />a piss OS~ti4+98 "'~ <br /> r n ~ c ~SUAp tiC~ 113LLS <br /> PERMIT NUMBER DISCNMGE NUMBER P - FINAL <br /> <br /> MONITORING PERIOD "!IVOR <br /> YEAR MO DAY YEAR MO DAY _ <br />~ <br />FROM TO N~1 <br />p <br />ISC~ <br />0 Rf~F~ 1 <br />~ hb form <br />in ' <br />!76711 l17- 31 17b751 176-771 178-191 136311 ~ <br />I <br />NOTE: ee rntru e m • a hl~ . <br />llet <br />p t <br />- PARAMETER !$Cerd Onlyl QUANTRY OR LOADING !I C+ni Onlyl .QUANT,ITY OR CONCENTRATION NO. FReauET+cv SAMP_L <br /> !46531 l54611 38-15 /06531 l5L81I EX GF TYPE <br />13I-371 ANALYA9 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS IeI-esl /54-881 169-701 <br />'IL AMD UREASE SAMPLE ~~,~,~~,~, ~ yu~ IG09,440 0>;446b ;~ai4k4 <br />V 1:, U A L MEASUREMENT <br /> <br />J4U6b 1 0 0 ~~~~~~t?f,RM1T. :: ~: ~ <br />6:o1~9tSC3.:'. <br />:: <br />RBPO.R1' . <br />ES=1 .. :3:11 M1~.Ik . <br />~ : .~#A$r 914 ~ ~~~4#4'.p 4~10 <br />:~ 91:74. <br />£gKLY <br />~SUA <br /> REQUIREMENFi .: . <br />. .. <br />~ <br />~ . <br />t ~ ~ ....:.::::.....:.. .... ...... ~.:. ... .. , ..: ;, .. <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMITS ~:5'.~ <br /> <br />.. .. <br />....... <br />:.. ~ y°~, ~: ;:r~: ~~ :.::...::..:: .~ <br /> <br />.. x <br />.: <br />.. ..: ~ <br />: Ry:;<.'~:- <br /> <br />.:. <br />. <br />,...:.: <br />~ <br />, , <br />,... . <br /> <br />. ....~:: ,: ,, .. <br /> <br /> <br />.. <br />' <br />' <br /> . <br />. <br />EQUIREMEN,.r~ : . <br />. <br />..: <br />..,:-.:... .:g <br />:.. .:...:... <br />: <br />~ <br />: : . <br />. <br />. . <br />: :..., .... <br />-r <br />.. ., <br />~:~::x ~:; ..,~. :.:,.. ~ <br /> <br />~ :..... ,,::. <br />. <br />. <br />- :: ~.i~ <br />.~ <br /> <br />t <br /> . <br />.. <br />.. <br />. <br />:: ,. <br />::. ... <br /> SAMPLE <br /> MEASUREMENT <br /> .:PERMIT <br />1. ~ REQUIREMENT ~ .. .~: ~ ~~~ ~ ~ ~: <br /> SAMPLE <br />'. •~ MEASUREMENT <br /> <br />~ ' ~ PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT . <br />- ~ ~~.:~PERMIT~ ~ - ~ ~ ~ ~ ~ - ~ ~ - . <br /> ,REQUIREMENT ~ ~ ~ ~ ~ ~;- <br /> SAMPLE <br /> MEASUREMENT ~ - <br /> PERMIT ~ ~ ~ ~~~ <br /> :REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT. ~ ~. .. :. . .~.~. ~ ..: .. .~ <br /> :REQUIRENIENT~ <br />~ ~ ~~ <br />~ <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I cERn <br />AM FA fr uNOER PENUTr of Lww TNAT I NAVE Pm9DNALLV ExAMINED ANO <br />MIUM WITH THE INFORMATION sU9MITTED HEREIN; MD eA9E0 ON TELEPHONE DATE <br />r <br />y. ~} <br />~ (' 1~ MY INOURY OF TH09E INDIVIDUAL9 IMMEDIATELY RE9POMSIBLE FOR <br />I BELIEVE THE 9UBMITTED INFORMATION IS <br />OBTNNING THE INFORMATION <br />p <br />L~ , <br />TRUE <br />ACCUMTE AND COM0.ETE <br />I AM AWME TNAT THE/IE ME t ~6 <br /> . <br />. <br />91GNIFICMT PENALTIE9 FOR 9UeMITTING FAl9E INFORMATION <br />INCLWING ~ <br /> <br />~' , <br />ITV <br />PR <br />9EE 16 U <br />1 1001 <br />T <br />P <br />B <br />f R <br />E <br />0 <br />ME <br />T <br />9 <br />C <br />D <br />~ ~~~ <br />)l ~ )I lG, <br />D' 1 <br />/ <br />~ <br />o ~ HE <br />O95i <br />IL <br />O <br />N <br />AND IM <br />19 <br />N <br />N <br />. <br />. <br />. <br />. <br />M <br />39 BIONATUR OF <br />PIIINCIPAL EXECUTNE <br /> <br />• U.S.C.1191e. lAMWtlr+I+WrN+r mron+el+Y NeI10+err+~rot10,000 AREA <br />J TYPED OR PRINTED +ns nnMAirIMn YASinrlnwntwMrw++nemwtlu rWey+Ma/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAy <br />'!M <br />COMMENTS AND EXPLANATION OF ANr VIOLA I IOn~ llfererenee an erreenmenrs nerel <br />SETTLEABLC SOLI US LINT APPLIES JNLY IP <l0YR,2UHH PRECIPITATTONS E1ENT IS CLAIdED. PER'IITTtE HAS <br />t~tlltDcN OF PHOOP NHEY RE2UESTING P.ELIEF PROti SETTLEABLE SOLIDS PRI27AAY LInIY~TICMS. <br />EPA Fam 3320.1 108.961 Previous editions mey be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 PAGE OF <br />A oo~sn~vac223-12s6 z <br />