|
PERMI77EE NAME/ADDRESS p.eAb Fmury Nawdlamm UDlOi.mrl
<br />NAME JLV:.Ci CvAi. .._~'': 'IY
<br />ADDRESS ~~ 1•, C, " =' •1
<br />an Y: ... CJ d1o3~1
<br />FACILITY
<br />LOCATION Ii A T .. .': ..' , :: 16 3 .)
<br />NATIONAL POLLUTANT DISCNAROE ELIMINATION SYSTEM C/VPDESI
<br />DISCHARGE MONITORING REPORT IOMR1
<br />l?-151 117-191
<br />.:.~Q'~. i1 :~L (~11 1
<br />PERMIT NUMBER DIBCNNiGE NUMBER
<br />MONITORIN ERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM C -'+ U TO %'~ =
<br />..~ .~o_~o, rvLRn
<br />form Approved.
<br />-- -. ~.:.~OMB.No.i204Q-000A ~
<br />(~ ,. ~r ~ ' , . ~) - ~ APProvelLexp(rtee OS-31-,98
<br />F - F?I'A.L i
<br />•,T 1(' L
<br />'~'•'~' NO DISCNAr. ~5 ~__~ '
<br />NOTE: Reed inetluctloru before completing thle Corm.
<br />PARAMETER l3 Grd OnlYl QUANTITY OR LOA! G 11 Grd Onlyl QUANTITY OR CONCENT TION ND, FREQUENCY
<br />DF SAMPLE
<br /> !46531 l5b51 !38<51 M653 1546(1 EX TYPE
<br />/31-371 AVERAGE MAXIMUM ~ VNITS MINIMUM AVERAGE MAXIMUM UNITS Gass! ,wAirss
<br />l545B1 169-701
<br />s h SAMPLE
<br />MEASUREMENT .. ~ t
<br />7v f ~ ^ {'::. ~.: 1,
<br />• I (./ ( 1 ~)
<br />O I
<br />
<br />Ut/+~') _ ., ,. PERMIT ro; r. r,.:,.- srnt{xk0 .. 6~c ff,". :l^°2 c,~r ~ :EiD LY i'i5?TI
<br />:~rvu^... .;ii03:, Y,~.LU~
<br />, • REOUIREMENT r:. ~;AICUI! "P.XItlU19 ;1'
<br />S~i,I.i.i,
<br />'P.iL SAMPLE .. ~. ~. ~•:.^COv 80tI9'.'O
<br />~ ( % +)
<br />~ ~ ??
<br />~
<br />~ /
<br />u : ~, .u ~, u ; _ MEASUREMENT J l~~
<br />L.J» > ti r.) PERMIT ,•; r::{: . .:::'sa;: r:: ~tkt0As5:.'v 7c ~Q N~F~/ ~ ~A9
<br />CL;,csl' ,_. VAL'J REQUIREMENT .. "p•is ~C!F AVG Lr:1.I~' "y +'G/:, ",nfiTti
<br />
<br />L~~:.: i, .:. _ '?L?'A'L'..
<br />SAMPLE
<br />..
<br />.'.~t9: t,
<br />/D ~
<br />( zr)
<br />O
<br />I L
<br />
<br />MEASUREMENT
<br />~ e
<br />\ • 3d Z!
<br />f.l~~'~1S l .. PERMIT ,-;r'. ,'„ ... .. {tAt:+fi=T FFFC&^' tcF^H.:. t 1 Hv ¢'/ ,riTi
<br />"r i.J -.IL ;h!:'S' Y%t" REQUIREMENT ... 3CD). A~^ C6I LY r~ 9L/I. `i ~3 r.'*4
<br />eJ SAMPLE .',. :tt0' U
<br />3~ D
<br />~~ ( ~) O ~
<br />
<br />~_ v ; (, ~ _t ~, ,. ~'~ -, , ,; ~ ,-,
<br />MEASUREMENT ,
<br />V . O vA.
<br />.,,v~r.V L i V PERMIT ... r. i}:~'~ .. {~#':; 7.~ REfDflT~ ! tiCY; f' :F.:i':
<br />F,.u:.',. ~~:J'.i.i VALJ~ REQUIREMENT ,.. 7/'j'P %Y~ CA?1° °;C ~';/L R'){iT:!
<br />;,i.. F. .`~:. .; 'tFAE.r SAMPLE .. ., '.~.: ... /, / ( 1~7)
<br /> MEASUREMENT I V
<br />.. J_':c 1 ~ U PERMIT 3's :=' .. ~ .. .... ,: r,tr,. -; ~. ?~ I '~Y'i I.% .ynL
<br />rF.,J!..,i ~i20:;.5 CAl:jl REQUIREMENT .. It^^ veY °•:/L '4T
<br />r.. .., LS .. i6 ii
<br />T: r. ,! T..". !. 1 'I i. L ~ ? 1 SAMPLE
<br />MEASUREMENT ^~
<br />I r pl,~ 1I ~ u Q
<br />I • ~ " ~ 1 ( ~. l) ~ ~' {:~::-;: r: ' /
<br />;ti J'>i i U J PERMIT !':?J'2T JP"ICJ !iAL ~ •. ;,f'. '. .. ~:':!,. ,:::: E°h LY 1119 ;'i. r,
<br />LFr..J:.r•; .,K6Y•S 6'.4LC: REQUIREMENT .iOpP. t11G UAILY `S:~ ~.r•.
<br />
<br />.. ~..: v.;, I.~r.
<br />SAMPLE
<br />..,-~. ..
<br />,-...
<br />- /[~'']
<br />1
<br />v
<br />(~J~
<br />( , 1)
<br />O
<br />' ~
<br />~'At~O
<br />i .i .+ ~ 1. i a .. MEASUREMENT I
<br />J L/ .
<br />7U?>s ~ ., PERMIT ....•~f.t -,. ..Y :.• ,. ....:~? F"'.C*.21 i°Fi~ I ~TY.LY 'S,q.:
<br />.~r : ~ U t_ :~ i .; !~ C .~, r ~i d L v REQUIREMENT , .. [ T ' t A :' - . R J 7 Y •, y :~ 1,
<br />NAMEITITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I HAVE PERSONALLY E%AMINED AND .~. TELEPHONE DATE
<br />AM FAMILIAP WITN THE INFORMATION SUBMITTED NEREIN; AND eABED ON
<br />TT MY INQUIRY OF TNOBE INDIVIDUALS IMMEDIATELY flESPONSIBLE FOR
<br />Q ~A.4 ` j Vo y~ PS OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS
<br />~
<br />~
<br />TRUE, ACCUIUTE AND COMPLETE. 1 AM AWARE THAT TNERE ME
<br />f
<br />~
<br />SE INFORMATON
<br />INCLUDING
<br />IFICANT PENALTIES FOfl SUBMITTING FN ~ fi
<br />,
<br />.
<br />/ SIGN
<br />~
<br />~
<br />~~ THE POBSIBIUTY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND 3~
<br />l li O V ( b
<br /> (/
<br />a
<br />Deo
<br />1,.rR.d. rvws ly ro trG
<br />I rate
<br />/nrrrov
<br />.sr srrr mvn, ,...
<br />c
<br />s SIGNATURE OF %IIN PAL EXECUTNE
<br />A EA
<br />
<br />~~ TYPED OFRPRINTED ,
<br />.
<br />. u
<br />.
<br />u.
<br />.
<br />Y
<br />,nsamulrwn myenlnleat o/ber.rrameneeaWeyval
<br />OFFlCER ORA RQED AGENT
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS 17ret'erence en arrecnmenrs nere!
<br />. ..., i.l ~... wri-I, •E I!''', `i nt.U SaT~: L1, .+i.-_ !L. .. r: LI' n''~!,. -r :r^ <=IC}; .. F; TC', ". .r, m. T'..
<br />.
<br />_.._.:. r.AJ1. .. ...: :i :.ICli .lni~~4 'UF. 77Q'f ~, :craft ~~rC rl. .~'i: ^I. F.T. rC° '~ FU*. r.4 ~T Cf)'); T;, I. A.., .7I1. .
<br />(~ 1 1 '1 f 4 (T ' l N T 4 f ~ ~' T 1
<br />EPA Form 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE UBED.I ~ r, C) ~ r. / O ~ I0 3 I - Iri I ! PAGE `OF
<br />
|