|
PERMITfEE NAME/ADDRESS nndubfsdiyNwdlaano. l/Dl~i..m)
<br />NAME ,yr>,tUU LNN~IK~ G,ORaUkaTtuN '
<br />ADDRESS p L~ tl iJ X b b ~ "
<br />i.KA1L. GU' tslc~
<br />NATIONAL POLLUTANT OISLNARDE 21MINATION SYSTEM (NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT ~ MRl B No. 2~01~40-0004
<br />I7-161 91 I; L'Jti~i (, 'ul. itit:~~~p4ovenl 'espires 05-31-98
<br />oiidit Nn 1L3h7
<br />l,B EIT NUMBER GE NUMBER r- F 1 N A L
<br />FAauTY ~ ~'~ ~
<br />G MO PER~SD M 1 Nt1R
<br />YPkl,S bNP IkL: t:G=R/CIItaTIG
<br />~ J ~ ~
<br />~
<br />MO bA
<br />TEAR MO DAY -
<br />Y ~ ~~'.
<br />LOCATIO
<br />-
<br />1h.kAll; Lil blo~~ FR~ 6 .
<br />+ ..9d 0'~ 30 t# ` DTS'~~+Aku[ ~t~
<br />A T T n n 1(: hA 1_ w . U D ' d N k 1" 3l /10 1 ~ ~ 176-771 175-291 13o-311 .':,: Rud imwctione bel a Pletlnp thN form.
<br />PARAMETER ~ 13 Cerd Only) QUA1tlTLTY OR.L4ADI ?t nly) QUANTITY OR C TION NO, FREQUENCY SAMPLE
<br />(37-371 - ~ 1~6-531 15b611 -~51 146-531 154-611 EX DF IYPE
<br />ANarsfS
<br />AVE
<br />~' '-MAXIMUM 'INIMUM AVERAGE MAXIMUM UNITS
<br />Y
<br />.,
<br />~L~r ~-UAY SAMPLE ~.;f.
<br />*####*
<br />19
<br />cU ~Cts ~
<br />[ MEASUREMENT ~ - .
<br />,
<br />..
<br />'
<br />-~' .:....:.P
<br />
<br />`
<br />17~.
<br />. `;
<br />: "
<br />~ ...,
<br />;i~lY~ .,...;
<br />:' .., ..,..~:. .
<br />?N
<br /><>tila~uttT ,
<br />Palk?`'';.::;,;;,
<br />:;<::..
<br />iV.f=F t..
<br />k3:Ard ..
<br />J
<br />.
<br />,~
<br />w I• ;8...641
<br />,1.... :: .
<br />. ,.. ~
<br />.
<br />. :..:::'d ;
<br />..
<br />x. ,
<br />:.::I~;i
<br />... ,; f f, ;w :~
<br />L~iJ~r T;;TAL ,,... 5!tMP.E. i•: ~#4# ,.
<br />i/~F'tlNUtu njEA~gREMEt:IT
<br /> :::
<br />~ -
<br />
<br />1. F
<br />
<br />.~,.. ; .~::.:.;....::.
<br />
<br />:s:...,.:., r..
<br />;...
<br />,; ,,,..,...
<br />
<br />
<br />
<br />.:.
<br />
<br />.
<br />
<br />,
<br />
<br />
<br />~
<br />
<br />
<br />
<br />
<br />::::
<br />.
<br />..
<br />
<br />
<br />
<br />,
<br />L.,nF 1.. ..i7N0U~I7 liK
<br />r.<1, TicLALYcNI PLAN7 ..
<br />MEAStJytE t'~
<br />
<br />~~ D3 ~ ~.
<br />~., ~I~k
<br />k ~1#v0+<:. i~f}{••r# -
<br />~d~~u v 0:, G '.PER IT:Tat
<br />
<br />' ;:. :..::..
<br />,,::- :
<br />r.
<br /><
<br />~
<br />~ :::::... ....
<br />.. 3~tPl~ i' :
<br />`
<br />.°'i ~.: r..
<br />.. ::~-...
<br />
<br />
<br />tit9P'#
<br />M
<br />~.~~#.~
<br />
<br />#. >,to-
<br />;;'
<br />^':: £
<br />EKLY.: 'ri$TAN
<br />' ~REOUIHEMEP.L
<br />F:. , ,;.:. .,,s}
<br />~
<br />.
<br />~`.
<br />,. ,
<br />.; ,. .:..~
<br />... .
<br /> SAMPLE ,pl,' ~ ,
<br />~" MEASUREMENT
<br />~' -,
<br />'
<br /> •t~:.. PERMIT. ..:
<br />.Rp+]~IREMEN7 ;,: ^s
<br />~ ~. .: ..
<br />..
<br />~ ,.~.:•..~::~.;~
<br />..
<br />. ~ •
<br />sly;,
<br />:~~.~.:~
<br />
<br />,.
<br />~ ~ ..
<br />f~~~~
<br /> .
<br />_
<br />:._ .
<br /> SAMPLE ~ " : "
<br />" - -• ~ MEASUREMENT ~
<br />. ,.: ~ ,q ~ ~:
<br />
<br /> Y,s
<br /> .,. ...,
<br /> S PLE, ~ ,
<br /> MEASUREf~ENT .~
<br /> .'try. ife.RM1T.>'~..:.: ~ ...,....::':•..;:
<br />::.
<br />r <::~
<br />:
<br />;: :~
<br />;:..
<br />
<br />~~
<br />.; ~~.GGIAEMENT :
<br />.
<br />. ~ . ~._ .>.. .:[;x: _
<br />•y:...:: ~•r, ~ ..5~».s;,.,. 2; <;.f~,. ~ . .
<br />x SAMPLE ~ ~ ,
<br /> fdEASI'lREMENT
<br /> :PFiRMf.;; :.
<br />~s .:.... :..: ~. .,s*4!y y:.~~.:,- s:sig.-.. .,.
<br /> :
<br />~ ` ~ ~
<br />NAME/TITLE PRINCIPAtr~XECUTNE OFFICER' I CEBTI
<br />AM FA FV urlDm PEN TY
<br />~II.E
<br />MILIAR WIlN I~i)J(A~E PEflBO
<br />it SUBMITTED H
<br />'X NAILT ERAMINED AND
<br />EREIN
<br />AND BARED ON TELEPHONE DATE
<br />' A
<br />~ Q ; -
<br />~
<br />
<br />
<br />~ MY INQURV OF TFIO
<br />OBTAINING THE INFORMA
<br />' b Al5 ~IMMEO1ATEL
<br />I BE6EVE•THE SUBMI Y REBPONSIBLE FOR
<br />TTED INFORMATION IS /
<br />~
<br />~
<br />/ ' ~ Imo- "
<br />/
<br />
<br />'
<br />' • L, f4^ 1 U '-1I I S TRUE ACCUMTE
<br />b
<br />SIGNIRCANT PENALit B F 17.EFE. 1 AM' AWAR
<br />BOOBBMMITTING FALSE INFO E "TNAT THERE ARE
<br />INCLUDING
<br />RMATION / :
<br />~ ~ J
<br /> , _
<br />~
<br />970 870-2712
<br />7
<br />si 9a
<br />Fi'VIr:11119'"ltd~ ~idll.i. er TNEPOBBIBIUTV OF NE DI MPNBONMENi: BEE 18 U.S.C.11001 AND 33 E
<br />IN
<br />EXE
<br />VE
<br />T
<br />
<br />TYPED OR PRINTED U.B.C. 1 tGls. d+.n.ls.. u.er e... moms Ary hmw rnrA to ro S IO,OOp
<br />wnnwimnr inP+smwrof arrNnemonNSWeywnl SIGNA
<br />OF PR
<br />CIPAL
<br />CUTI
<br />UR
<br />OFFlCER OR AUTHORIZED AGENT gREA
<br />CODE NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />GOMMEN75 ANU tXPLANATION Vh ANT VIOLAIIVNS INeference en ertscnmenrs Dare/ "
<br />t i,r ~;ltfN l" ~A;^i'Lt'> rtU;T ai- GULL~CftU e ArvaLYLLO L ~EN1-IKTcU :A.L:MiMLY sic ua;luL c;S .,F 4,nc TfiCR aN EFFLUt:NT
<br />L1~l.NAKist LJ L. L.UhS•
<br />EPA Form~3320-t 105.95) Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF
<br />OOo6v/5c1uU1-1311 1
<br />
|