|
PERMITTEE NAME/ADDRESS p.r3i4 FrreryNa./Locerren 4019 rart1 ,;f
<br />NAME I( F. ~ : ~ C .) 4 L ~. "~' .", '+
<br />ADDRESS tl A 1 ~~ I: I =' -~
<br />Y.u.4H:11: '7 is f
<br />FACarrv
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT IOMR)
<br />l1-I6l l17-191
<br />~~;A50C37 L.v. e
<br />PERMIT NUMBER DISCNNiGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM J l L! J TO ., 1 J~ j
<br />I]61I1 l11-131 114151 lI6Dl lZ8-791 136311
<br />Form Approved.
<br />P:/kA a/T~tR TIT Gon~B,NoA2oao-pgog,
<br />(j L• r c rl W ~ Appiovd expiros OS-31-98
<br />F - Fi 'itL
<br />r;.,:~
<br />:, (: I,` ,.~ JI9;'.:A~' F ICI ~':::
<br />NOTE: Reed Inetructlone ltefore eompletinp this form.
<br />PARAMETER !3 0.rd On/yl QUANTITY OR LOADING !1 GN Onlyl QUANTITY OR CONCENTRATION
<br />' ND FREQUENCY SAMPLE
<br /> !46531 1546'71 138451 146531 1546
<br />11
<br />EX OF
<br />'
<br />l31-371 ANALYSIS PE
<br />T~
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re7-e31 !54681 169-701
<br />'1; SAMPLE :=G GGt.O Ort :: Q:J := ,:,:<: ., { 1 ~)
<br /> MEASUREMENT
<br />~l: -, ..'J 1 D J PERMIT ;.rtn:^: :: I, ;. {: 0:; .. ,!'.
<br />. :. _::~;: :r 9.0 c~i i'LY ~NSiTU
<br />: :'L. J.:N"f .;kJ>5 Y6LJr REQUIREMENT ~' *.'Or-~ N ilsii,.il ?tA2I ~Ui.: 111
<br />~~.:.~SE 5b'I'TLEA9L', SAMPLE u~F~;:;:•: r::OR4r ..~... {:r::;; :;: r: ( .'S1
<br /> MEASUREMENT
<br />.r .,~ 1 Ii J PERMIT av.cL~ISa RriCtC;1.d
<br />• ;:CIO P~::OrkC: i:fiC%+= ()s~5 ~ ! tLCf:/ :'Rilq'
<br />...:I; `t; ,:h)i5 VIILUt :REQUIREMENT >:;rtu DAILY ?:X ?"L/L ?10Ni±
<br />.1 .. ,. '. D ~ rt F A i L SAMPLE ~? P 7 ~ F ;: : ;: ry .p :} ;:.} ,. :;::,::,. .. :. C. { ~ ~
<br /> MEASUREMENT
<br />,' ~ : U 0 PERMIT :;:{1 ;r 't :. EI r,:G •s r,-GU ti rl r::; a:c4~ r:.; :f :::. •: ~
<br />L i. I n': i^Z'i :?At
<br />.. .,-.~:' .: F'7. '_~ ':: '.. 7;: REQUIREMENT r,: ti::] I:?!?.Y "!' ";/L ;`.~}fT
<br />-... E _ .. ~ 0 ~ ~ :I . SAMPLE ( -~ t j
<br />_, .C n ,. ~ T ,, ~ ~- ~ -, +' MEASUREMENT
<br />
<br />. ~ ,.
<br />- 1 G PERMIT:"
<br />,
<br />):-°i:)!13L REPO$Z' JF~:~G•; -.... :: C: r~::.. V:. ."•'/ 'i`-~nr:
<br />.cL;,U.:/i; ~P~: ': ALJ" REQUIREMENT 3+%DA AY:, ~D~ti,:+l~:'~.l1X 1^.GG ~ '::::: '~ ~:.; ,.i4
<br />,1.. AAU 6RE SAMPLE ~=hac;:n ( a{f ~ L: ~: '... I; ',=4'?'~'::
<br />!i_~:AL MEASUREMENT
<br />.4)-,L i G J PERMIT 0~~:: rt S=S' '[''P GE•.°, Y ES=1 :Y r,::;a•i::. ;i ~'r4 t; rcr,::.re :.+,: c: :: ... ( .; :•I:! T'.pP. '.
<br />'. t i' L-'f !. Ir ! is :? 5 S Y A L 'J F REQUIREMENT i 1: ^ ; ?1 :9 $ H 0= G 'P'}'} C: H ": T' ti
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT.
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENN.TY OF
<br />AM FAMILIAR WITH THE INFO LAW THAT I HAVE PERSONNLY ExAMINED IVlD
<br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />kiDl'lBld A. M111160Q OeTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB
<br />
<br />+ TRUE, ACCUMTE AND COMRETE. I AM AWARE THAT THERE ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />f~DR Pte6SdeAt , x
<br />~
<br />72
<br />~
<br />Ol
<br />O~
<br /> THE POSSIBILITY OF RNE AND IMPIIISONMENT. SEE 18 U.S.C. 1 1001 AND 30 t:IONATURE OF PRINCIPAL EXECUTNE 7 T~ IZ
<br /> U.S.C. E 1]te. !lMrWew MW IMw .nnm. mry b,cA.W fires. W ro f 10,000 AREA
<br />TYPED OR PRINTED ..a rnMaim.tt irOrIANMInr W Mrwwn a rrrmeMW 6 rE.n.l OFFICER OR Al/THORIZED pOENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Referents sll sttechments hers/ ---
<br />`i1:LEAdLC SGLI~`-i :.I"I?' yP.I~'~a FU' 1J-Yfi. 111-?a ~il~;I"' ~.7Eda ~~;irJG~l i0 J:!LL~:~ I'f' 1~'R;~'lr '-.~;'?-. ,.. _ ...
<br />'11 u.C1 I. ti. L. UE I'. !:. :, CJ?":M is ~e ~~F.~A~".FVi PLAY DU.`: 1-1'J'.
<br />EPq Form 3320.1 108.951 Previous editions mey be used. (REPLACES EPA FORM T<0 WHICH MAY NOT BE USED.1 ~ ~ i ~ ~ 1 PAGE ~ OF
<br />
|