~~ ~.
<br />PERMITTEE NAME/gDDRE55 (f, Yb FacWryNwV(,ecanm /Ot~ir.nr) NATIONAL POLLUTMIT DISCHMOE ELIMINATION SYSTEIA INPOf$/ Form Approved.
<br />NAME ~' ~ ~' - ~ ~ ~ ~ - DI9CEIARGE MONITORING REPORT lOMRI
<br />@-181 l17-191 ~ ~~ ~~ - ^ OMB No. 2040-0004 ~ ••
<br />ADDRESS - ' •- i e ~ ~ - ~ ~ :.. ~ •. -' n - - ~ ` c l ~ ~ , ~ - ~ I Approvt4 expires OS-31-98
<br />~ -- - ~ . , PERMIT NUMBER OISCNMOE NUMBER - _
<br />FACILITY ~ ~ MONITORING PERIOD
<br />LOCATION YEAR MO DAY YEAR MO DAY
<br />_ FROM I I, ~ TO .. ~ - .. I -__ I :
<br />I ~ ~ NOTE: Raed Irotruetiorr belae com I p
<br />' - ~ ~ ' r !76211 177-731 !14751 176-771 118-291 130.3/1 P elfin this form.
<br />PARAMETER I3 Grd OnIY! QUANTITY OR LOADING !1 Grd OnIYI QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br />l37
<br />J71 (16-531 15/-61 I3B-45 !46-53 I5b611 DF
<br />- EX N
<br />uY~S TYPE
<br />
<br />- AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Ie7-ssl 'a
<br />'
<br />164681 169-701
<br />;. SAMPLE
<br />MEASUREMENT ' '. ~: ~: •::_ .. .: .:: :...
<br />', ~' ....:, ..
<br />~% ~ S 1 .Y
<br />~1 ,~
<br />/' ~ ~
<br />(yl ~~
<br />.: (.' PERMIT "t q • -. ^• Y• ~ ~ r •; r. i .:t . . o
<br />,. 1' _ - ' . ~ ,r - ~ I . REQUIREMENT -
<br />~
<br />ti T / .' F . • ' ` i ~ •- •. ' SAMPLE ... [:.. ..: _ ;..., _
<br />
<br />MEASUREMENT
<br />N ~
<br />~I {~ I ,
<br />nl /`
<br />N {i
<br />n~ /~
<br />• .'r i' '' PERMIT 'Y:~h:g rr •'. °t r:a-.het $. n+.. .. ... .,. e(r= r^pr. nr n• I•^ .
<br />'
<br />V I,. T ~
<br />. .
<br />C :, ~ •. a" '1 s REQUIREMENT is ..}f. 'Tn •,y y. ..F-r.r :~• /I, "(1t: Tft
<br />. ~.._ . • ~ , . ~ ~'•. L t ' I ` SAMPLE ': •r r:.. ,..: r: •;: .. ...r..,:.:. ; , ~
<br />I I
<br />'/ /
<br /> MEASUREMENT C 0. ~ ~ ~ , I j (J ClF
<br />A
<br />. `...1 .C ii PERMIT ''a ~: ': r G .. : r.. .y . ... : t _
<br />^t ..:-f ,oa
<br />,1.•r. '.R GR~i" REQUIREMENT ~n-. c tv `- ,
<br />~
<br />_.- .. '. i. :FF.AS'' SAMPLE _~~. ~ ~
<br />~ ~ 'r;:
<br />~ ~ ~ ...
<br />I ~
<br />_, - v i',~,_ ;~ `-. ~-.~ MEASUREMENT /11/~ NA IV
<br />/q N/.~
<br />t' . ~, ^ 1 17 ^ PERMIT ~ r' :' ° : ~ G .~ G .: r... r.. . -.,.. . , ~ :
<br />' 1 ;
<br />I
<br />U , ., REQUIREMENT
<br />. ~
<br />'L~ ~~ I `~ ~L'~(i'rT SAMPLE ~ 1 °~ ... ... .I .. ~-
<br />~~' T T
<br />J I
<br />~ MEASUREMENT ~ 0 z S f Q
<br />(~
<br />0 g(
<br />.
<br />~ -
<br />/
<br />1 v . _ •`7 G ~ PERMIT ~ ~ ': '" :i c ~ ..~-;, ~
<br />.G: ~n
<br />~ ..~ • ~
<br />.... ..
<br />..
<br />_ ~ ,. ;I 1' .~ •..
<br />~ REQUIREMENT t~•, ;1 kY~.; is ~.I L
<br />" '1
<br />~ t sr( .•
<br />
<br />•
<br />, s,, ~• I,-...-'
<br />,_
<br />'
<br />' SAMPLE :~~. .,.; [: ::
<br />
<br />~ ` ,
<br />y ..,.. ,,:.:.
<br />
<br />~/
<br />",
<br />, •
<br />[, MEASUREMENT 3 ~ 1~IJJA
<br />•1 ~~t„ ' I' PERMIT .::r:^r• 7 _~ ~..._ .:I: .~~~. ., t. ,y. ,.
<br />- -. ~~ . ~ ' . .: ~. 'REQUIREMENT 7 }~ ' 'I '~ " ~ ..
<br /> SAMPLE
<br /> MEASUREMENT
<br /> 'PERMIT.
<br /> REQUIREMENT
<br />NgME/TITLE PRINCIPAL EXECUTNE OFFlCER I eERnFr unDI:R PENN.rY DF uw THAT I NAVE PERSO NALLY ExAMweD AND TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED H EREIN; AND BASED ON
<br />1y
<br />C Viz Y'CI 1' Ills MY INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMAT
<br />I eELEV
<br />ON
<br />T
<br />~ryt I
<br />,
<br />E
<br />HE SUBMITTED INFORMATION IS
<br />U
<br />r
<br />_j.VlYai?1i8`7:'~ i ,`:C~';~_Y SIGNIFICANT P
<br />ENKT~S FOR SUBMITTING FALSE MFORMAT
<br />ION?NCLUD NG
<br />' 77~ (i~]n-?7.r19j '17
<br />7G t•^
<br />J
<br />
<br />THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE to U.S.C. 1 1001 AND 3] u
<br />
<br />
<br />TYPED OR PRINTED
<br />u.s.c. I t]te. rA.nru., uldor dws mtm.,.,r.r NcAdo 6.Na Im ro sro,aoD
<br />uM Ormul+,vni.wivnweo/Ntrorr enlmMrt ondS FOrs/ BIONATURE OF PRINCIPAL EXECUTIVE
<br />
<br />OFFlCER OR AUTHORIZED AGENT
<br />
<br />NUMBER
<br />
<br />YEAR
<br />
<br />MO
<br /> CODE DAV
<br />.,vmmo. ~., .......,...n ............. ..~.. .~...... ~..~... L... e. enter rn susarnsns nrrr/ -_
<br />• ~• '.
<br />. T r.. ~F- / r • ..
<br />EPA Form 3320 T 109 951 Prevloue adlDane mey be used. /REPLACES EPA FORM T<O WHICH MAY NOT BE USED.1 .. , I ~ I ~ „ , , , _ ~ , PAGE I OF
<br />
|