|
PERMITTEE NAMEIADORE65 n.dJrFrWryN.r/laane.IJDlpwwq
<br />NAME T1:APPFR `TrI"^~ *v'.
<br />ADDRESS TRA PI'~;R ~'I'1"
<br />p.0. k7!! 1'1
<br />L: r~A i : ., . R17?5
<br />FACIIT'
<br />LOCATION
<br />'.i ~j,•[~1: Q• I.~.3D~_' ..m FTrrr +. R'(:, ~/rv} V~)
<br />NwnoNAi POLLVTAnr DISCHMOE EUMINAnON SrsrEM !NODES/ Forth Approved. ',..-:
<br />DISCHARGE MONITORING REPORT lDMRI y T R ~ n OMB No. 2040-0004,. ~~ ~ '.
<br />l1-16/ 17-19/
<br />,- J .- 11 010 A (5 n o P ° ! j Approval expires 05-b11'~~
<br />PERMIT NUMBER DISCHMGE NUMDEA r - c T M ~ 1 - ~ A'{~j
<br />MONITORING PERIOD ~ ~ .. ~ ~ T~~ n I' t ~~ t ~ Et. v , .."
<br />Y AR D YEAR MO OAY ~~'~"``
<br />FROM TO {c ,". .: B9 nT r(`:I p:~.-tr ~ ~ .y.,,
<br />$.
<br />l262v !zz-231 r2a251 !26.171 116-191 !36311 NOTE: Rssd Instruedorr Mtol~mplstlnp this form.. ~i''
<br />PARAMETER !3 Card on/yl OUANTITY OR LOADING
<br />l46.531 5I-611 !1 Ord Onlrl QUANTITY OR CONCENTRATION
<br />38-a51 !a6.53 151-61 Np, FREOUENCr
<br />DF SAMPLE,
<br />l32-371
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS EX
<br />
<br />fez-6Jl
<br />ANALYSIS
<br />161-6D1 TVPE
<br />
<br />!64701 '
<br />'~t SAMPIE r ~ C C"'.kRR3 ( )j
<br /> MEASUREMENT
<br />
<br />7•:'400 1 0 1
<br />':. }`;'LUEtIT GROSS Y1 t, [T. :-; 2. RMIT....::
<br />REQUIREMENT;
<br />~~ ?.::' . :.:.:.::...:. ::.:..:::. .'.: ,:.
<br />:~~ Y:3a
<br />>x4D13 ~ -'<.r.:':.':.';.-:.;
<br />~I(jr•j(~.~4j~j_ .:...;:.:::::.:..~ ::.
<br />_ ~..',... ..'.:;;:;',
<br />j(~X,'Z "STF !l ;::
<br />S
<br />
<br />~~ !:K![LT ..~t'°~: '~~.
<br />"-~^• 'mss SAMPIE ~ ~ ~ ~. ( 19j
<br />i U 5 P f; N D F U MEASUREMENT -
<br />
<br />UDSJO 1 D D,
<br />
<br />
<br />
<br />
<br />: !'FLUENT GRO55 RALii
<br />
<br />
<br />..FERMIR,'f:::
<br />
<br />IiE.QUIgEIAENT.
<br />:..
<br />
<br />
<br />':::.:.. ..:, sa
<br />,..,
<br />
<br />' '::. .,,,.::..:~:..
<br />
<br />~,. ,2>,
<br />
<br />3t
<br />
<br />
<br />O~Att6
<br />
<br />
<br />
<br />::.,
<br />
<br />:..
<br />
<br />;:a
<br />
<br />
<br />!~~sD~., ., a
<br />
<br />...
<br />~:c:.•.::;c;,ay`:;:'4`I
<br />
<br />(SjI:Y.'LY:-lj7E
<br />
<br />
<br />
<br />
<br />~/L
<br />
<br />
<br />
<br />
<br />COlIL'~
<br />
<br />
<br />
<br />
<br />/
<br />. ~. SAMPLE
<br />MJASUREMENT ~
<br />f~j~/ f ~ ~ 5
<br />U5tl5 1 U 0 ?'. ,2:'PERMIT . ': O':C 4JN/1.L..:, :. L', Q.?'l r.T. !;
<br />r:Ff'LUENT GRO55 YS'.U %AEQUIRENIENT .: ..... .. :.'....' ,~,." iY A.X:` `~kF~.w.-a)F 'rL/I. ` ~OMT,!L ..:..':.}
<br />• • SAMPLE ~ ~ '"
<br />(A ; P E ~ MEASUREMENT _
<br />
<br />' 1045 1 O ) ~ ...:"PERMIT' . ~~ ~ ~ ~• Yr 4=FC ~... .. - :~...~ ~•. .'t ..
<br />.(. `.
<br />::PFLUBNT GROS; Y+L',! REQUIREMENT >r3cs Lt)rt)1 .~YG: "!,ALL:F r'~. .-;/:. .
<br />~ SAMPIE ;T ,. ,.v ~=. ,. .. , ,- .. ,... ... rr.. (
<br /> MEASUREMENT
<br />
<br />135rs2 1 0 U
<br />PERMIT .~ :.
<br />~: ~:.;
<br />. ': ... ~
<br />::... ~ '~ .....
<br />~`~`~
<br />...
<br />~:PFLUER7 GROSS YA i.U .
<br />:REQUIREMENT. . ~#rR -.,.. Z'~`.~'r.'...~4'lS- MG/L r$B1':. :,: ::':,. .
<br />~~ SAMPLE
<br />T:{i{U TxEATr.ERr PLr,fi', MEASUREMENT
<br />
<br />~UUSU 1 U D PERMIT ri. .v' ,"r-.,. #>r~ v.
<br />,,aT,.Y
<br />;.PPLUF.N7 Gft055 YA1,U. REQUIREMENT 3044. A.ttG. .DAtLp ?Si: f1CD #':"`-
<br />' `~ ~ • SAMPLE ` '
<br />DISSOLYED MEASUREMENT
<br />
<br />rnz95 1 0 0
<br />::.PERMIT ~. ~ .~.
<br />- «- - -r
<br />. -.
<br />:...
<br />~.
<br />
<br />,
<br />I
<br />r:F'PLUENT :ROSS YILU 'REQUIREMENT. .:.... rr~G .
<br />(~.gT~..Rti.; fIA,T.S.T.
<br />:~t ~C/!.
<br />NAMElTITLE PRINCIPAL E%ECUTNE OFFICER 1 CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />RMATION~DUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br />
<br />W. Gordon Peters MY INQUIRY OF THOSE IN
<br />ODTNNINO THE INFORMATIDN
<br />T0.UE. ACCURATE AND COM
<br />SIDNIHCANT PENILLTIES fOR DINDUAL$ IMMEDIATELY RESPONSIDLE FOR
<br />, I DEIJEVE THE SUBMITTED WFORMAnON ID
<br />PLETE. 1 AM AWARE THAT THERE ARE
<br />SUDMITTNO FKSE INFORMATION
<br />INCLUDING
<br />•
<br />970-824-4401
<br />49
<br />30
<br />2~
<br />?resident/General *fana er
<br />g ,
<br />THE PDDSIDILITY OF FINE AND IMPNSONMENT. SEE 18 U.S.C. 1 1007 AND JJ
<br />tiIONATURE OF PgINCN'AL EXECUTIVE
<br />TYPED OR PRNYTEO u.s.c. f tJts. lPawleEE IYWr dNE. a:.Ilm• nrr ArcAlda An.a w ro 510,000
<br />rdo'nsvrmurr tisNOtnlAVrorMHr.uremena•sM6rwal ~ OFFlCER OR At1TNORRED AGENT CODE NUM6ER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLAI IONS f/fs/srsncs s5 erlyenmsnn naTSl
<br />__ E TOTAL IRO" LIRI7; WILL '3'' GAIPP,Dr AAD S>'TTLFA9LE ;~LI~S LI`II* F?^'I"~ <'SO~`:~~41ty aP.rla FY~NT-
<br />.>;f; HURJEh Oh' PROOP pF'UIR~MENTS URDRP. I.A.3. 'DS I.ONITIIRTNr - I. q. 3. "ir, S ^e ,E - "D£ I.4,1.(D1.
<br />f0 DAY A'!EI'AGE IS PiC"F.ST !111.M '""LT AY ERA~a DURI9: PERin!? 4EP~4Tq Df
<br />EPA Form 3920-1 (08.95) Previous editions maV be used. (REPLACES EPA FORM T10 WHICH MAY NOT BE USED.) n n T T 1 / q ~ n ~~ ~ _ 1 n ~ D PAGE ! OF Z
<br />
|