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PERMITTEE NAME/ADORE93 (/+ebd. Fruiry Nw/(eraNm I/alaGnu) <br />NAME KL3N CU).L ~J^1Patif <br />ADDRESS '1 h k is n I ~, E <br />1'.0. 3JX 77JJ`11 <br />STcAlblhi ~PI;I':,:; Cp 90u77 <br />FACILIT' <br />LocA710Ny ALur:A CJ b~'JBD <br />n l'T;I; :iCUnCt J. P!.PTF.hiJN. 72li [-, y:ii. <br />~.'.. 4:. ~.: r.n- -.... .... -. .~ <br />IcR71xG~ClMIrrAT1oN!sr - T/JPD~~}'~- - =~=, --,..-__ <br />_ ..---vlawn„ ~......~.:.-,..,.1•..-.,cc+m+.a...oo, irl•~1~~__lr`~w1E~i(1 u -w <br />11-161 17-191 ~~'J~1~ i +yy <br />Applvve ex it s O <br />~acesoo3~ ~ (sosR nr~ rglP, <br />PERMIT NUMBER DISCMMGE NUMBER F - FINAL I <br />MONITORING PERIOD n I N O R `- <br />YEAR MO DAV YEAR MO DAY ~~ <br />FROM ~/ U TO yy W #;t NU Dl sr_HAkG r; ~ XdL1 "~+` <br />I7n1f1 I1L131 III-151 I74v1 178-191 l3a911 NOTE: Reed Inetruetlqu before completing this lorm. <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !I Grd OnlYl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> !44531 l546f l3B-451 !44531 l5I-6! EX TYPE <br />l31-371 ANKY4s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-s]1 !64691 169-701 <br />YH SAMPLE #p7yp,^- ~7RPO: ;kG ## ( I2) <br /> MEASUREMENT <br />JJyJO 1 D D PERMIT:, <br />: <br />. #+a91v~s OSra~K# ### 5.5. ~';+~$ # 9.Q I.EEiSLY N.SETU <br /> <br />}FFLllP>.T ;HJ55 YALIJc .. . <br />,.... . <br />. <br />REQUIREMENT- <br />ail#R <br />lLNIlLU3! <br />i$AXT.ZRUH <br />•U <br />SOLIDS, :.ETTLEAcIL° SAMPLE o0ls64 4G#004 pa;ro;t>< V## .•# ( 25) <br /> MEASUREMENT - <br />uJSJS L 0 0 PERMIT ..r .zs:0191RlEq:O'::::. :';.P.p.;aCtii3.. tr~1# 06f401:4? +RfY491.lr '. ~:5. .. qCE/ : {$AB <br />cF'r'LU(:tiT ~flU53 YALUE .REQUIREMENT ##ph DI !Ix nL/L MON <br />JIL AkD GH°A$E SAMPLE #73'kRd #x3?S:~ 53?445= +krFC #:: ( 19) <br /> MEASUREMENT <br />1, <br />~Jli2 I J D PERMIT G#::p$R {:G7RC# ;t:k:k :O~Yatil# :I#4t: 4` I.Q I ~:3xIN ;RAB <br />t FFLUEN? ;;HO$5 VALU E `.REQUIREMENT #:?#p <br />i3ATI,Y nX <br />YG/ <br />GEC <br />r'LJyr Iti SUN D'JIT JH SAMPLE ( 03t' SF~#;t:k~ 4'G+.= ## ::{=; ~': I:# <br />1'n'r.U ?flLALCENT PLh?iI MEASUREMENT <br />~Ou50 1 D J PERMIT PT IINAL R',PJRT ~#~kp# :sY#~ ~` +r'#Wfsi=# #:I: ( w^F'/ "NS?il) <br />tYYLUENT ~RUS` YALIIc REQUIREMENT SUDA AY(; DALLY 'iX ncr, #c:;:# w~NTH <br />;iLL AkD GHF.A$E SAMPLE +=4k:k+~ ( 9j) .~,~. . ~>:. ',~(• {<Yy;:r',:'.: <br />Y I .i U A L MEASUREMENT <br />~ <br />huJbo I D D PERMIT .:::#axa REPOHY Y E,=1 ##riaa# #:~,•~. # ~a;~.al;:a ? .##* t i1Cf/ II5UAL <br />EFr'LUENT ::FJSi VhL'Jr :REQUIREMENT I9ST TAY HC=J #';•#~~ `SOtrTt± <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME(TITLE PRINCIPAL EXECUTNE OFFICER 1 ceRTIFr UNDER Pwur or uw rNAT I NAVE PEnsoNALLV ExAMINEO ANQ <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED NEREIN; AND BASED ON - TELEPHONE DATE <br />~F.~~ <br />H <br />n <br />i <br />d A <br />t MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR i <br />1 BELIEVE THE SUBMITTED INFORMATION IS <br />OBTNNING THE INFORMATION ` <br />u <br />eori <br />c <br />. <br />R <br />rr , <br />I AM AWARE THAT TNERE ARE <br />TRUE <br />ACCURATE MID COMPLETE <br />_a <br />' . <br />. <br />INCLUDING <br />S <br />IFICANT PE <br />TIES FOR SUBMITTING FALSE INFORMATION ~ 7 <br />}1iQ21 ~ D4 <br />~6~Q~IIt <br />VIOe A. , <br />IGN <br />NK {, v7 <br /> THE POSSIBILITY OF NNE AND IMPRISONMENT. SEE 18 U.S.C. f 1001 AND 7] /SIGNATURE OF PRINCIPAL EXECUTNE <br /> U.S.C. 1 1]1e. lPrWtlr, carte' eww mlvhs mry Nch,YI f]ws up ro SIO,<b0% <br />TYPED OR PRINTED ens o.mainun :nPdwm.nr of MnvttnemenNaeM 6Ywn1 ;~ OFFICER OR AUTHORRED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lReterencs ell effecnments nerel <br />~ TTLEAt3LE SOLIDS LI11IT yAIYEU ROIi LJ-C H, ;:1-.ifl PRECIP EYF.~i• ~uSJc~i 10 3UHDEN JF ['9JDF R?;ItIIP.~`J°NT3 IN <br />lA.T I. U.i..Dt P. 6. SfJkyYATEH tlhNAGE1ENT PLAN DUe I-L-?3. <br />EPA Form 3320-1 108-95) Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ~ 2.3 7 ~ 9 7 D N 1 `1-12 S 4 PAGE L OF <br />