|
PERMITTEE NAMEIADDRESS 8--"-ssleyNr~lamlan 1/OIQvs9
<br />NAME TRAPPBI' 'LVL' ", 1"".
<br />ADDRESS T V R ? V r, h' " ] ':' ~.
<br />P. n, a-~x 1 1
<br />FACILITY
<br />LOCATION
<br />TT~11 d. ]C`~fr'1' ~ ~ ~ .-S~ .errF' :I'. `Y M':4
<br />NATIONAL POLLUTMT OISCNMOE ELMINATION sY6TEM /NPDES/
<br />DISCHARGE MONITORING REP011T IOMRI
<br />l7-I6I 17-191
<br />00032115 0!13 p.
<br />PERMIT NUMBER ascNMCE NULIBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO
<br />Hain /17431 /1I-P51 176171 118-791 136311
<br />Form Approved.
<br />~! • ry 7 o OMB No. 2040-0004' ~ ~ t. ,
<br />{ S'1 R A q yrl APProvel expires 05-3{,g8~"+L,,
<br />'+~•e r:. o~ Tn ?A:, arrq~p4r; ,'li C'4. iL~ f
<br />~`. ~.~
<br />.NOTE: Re6d (neweOiaFw 66foT6 compl6tinp thb form-
<br />PARAMETER ~ !3 Ord onNl QUANTITY OR LOADING H 6rd Onlyl QUANTITY OR CONCENTRATION N0, FREQUENCY gAMPLE
<br /> 116531 /5I-6tl 138-~5/ !16531 151-511 EX T
<br />E
<br />131-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-6J! ANAEY45
<br />16f-681 YP
<br />!8&701 ~ '
<br />.. SAMPLE ~##xp° 4#RSRr ?"f: #~` ( 1 ~)
<br /> MEASUREMENT
<br />;U40U 0 7 1'SPERNIIT:`'`: : .: .At#.
<br />:.:.J~ ?'z4$#,:. :'. :;:C . ..
<br />r`_1:::::; :.... . ... .J. 3<#~..: 4:.!):. .: ...:, '~ 8.'~KLY ?:.5~~
<br />F°LUE' '.:?7i~ 1AL.U REQUIREMENT .
<br />'. #vC# .
<br />g~~~.~ptj{I( •]~>L.iP11)l4::: I(1
<br />1LID5, ~'TTL F6 -I L,p SAMPLE ###O##. R+?OR4`# 1!##### ( 75)
<br />' MEASUREMENT
<br />"OSI.S L C C '::.:PERMIT:.:. ##•°..
<br />. (11', :.,:. ###
<br />
<br />..,.
<br />. ....:..:..
<br />: ~~`~. ~~Lr:::-. a(. r::::;":::. a:^:;.'.
<br />.
<br />
<br />.:: :.
<br />
<br />:.:Ir..
<br />;_~
<br />
<br />t. FLUENT „R9!i5 ., 11 ..:.,
<br />.REQUIREMENT
<br />.:. ..
<br />
<br />..
<br />A.
<br />~
<br />...
<br />#### .
<br />.
<br />... ~~..:::..~:i:>.::c.::.:.:
<br />.'.. ~~:.:~~;.~: .
<br />:~~:Q~~~:~.~:.:~Uft;.
<br />ML/L
<br />...~:.~::,
<br />:.:f!)~~:.
<br />.
<br />~:~.~.~.~.. ~>
<br />.. >_ .a SAMPLE ~
<br />'t# ,.-. t1 #'#### ##4:S!' ( 19)
<br /> MEASUREMENT ,~// /'J~'f9ilpG
<br /> x
<br />-•~...
<br />'rLUENT 6@C1 `. ..
<br />~~REC1tli~ll"E. ~,
<br />. ~.::r;..:..,,~ ~,:gq ##r# .<i~t.~~~ rMi^ Mi~I. •r/I. N '~~
<br />,,..
<br />~
<br />!
<br />~
<br />~
<br /> t •r~
<br />,.. . i
<br />:
<br />~.
<br />~
<br />
<br />;U TF'EATHR.k, ^LA'' MEASUREM~PLT
<br />~u;ti0 1 0 ?+ PERMIT:::';::
<br />.
<br />::: O. T.
<br />.. ¢ r .: . ':A# ~ ~ +~.r.nn,-„ - - .?k {.T tlN
<br />-r''LUENT GR7 7; YALrIS ,REQULRENIENT-
<br />. ,
<br />~:.'~A`>~::.iCa~!;. . ,
<br />:~..t1.lILL~~~:.4~.1"~i.' hGD~~ ~ ... ., .., ..:>.~.;~:~
<br />:::..: -. _-. .~
<br />,:) '~, 0 SAMPLE C:=.•.,'• ~,-tR~ # e`4##t'# ~ { 7 ?)
<br />(SIdSOLYED MEASUREMENT
<br />/0245 1 (1 .: ~i•::~~:ERIvIIT
<br />:~~~~: ~. ~~:.A ...x .. ..:.
<br />. S:#;: ..SR:. #~ ~.t .(:•1.:~:~'1"::)R:
<br />~~:~~:~: :..:.•(1~~'$#Y .~{~~~ TRLT :ifx1F
<br />
<br />'. f'r ].UEkT G4J ~ ipf•U .
<br />,I).~Pl71REMENT~
<br />~. ... .:~. ~....~.~.:. ...
<br />,
<br />':.~.:::. ~ ::.. ...:~ ~
<br />+GYF#
<br />~.~:.. ~.:~...... .
<br />...~.t~.R1`!P:. ~;~.~.~~:~~
<br />..:~7 +.1't'.LY~.. ~y~
<br />!ICIL
<br />:~
<br />• ~ SAMPLE ^ '
<br />V ] . ~ U A L MEASUREMENT
<br />~Obb 1 U " PERMIT: ... ....:.: ..: Esf.
<br />,; .:. ES=1 ;':: .: ,.. . r>r.. #ry :'?]lu,
<br />Ft'LUEMT GR:•:'; 7A" .REQUIREMENT, ~:~51'.LIA'd. 170=0 ±~}a.•
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~~ PERMIT .~ ~. :.. ...
<br />,. .. ... ~ -
<br /> .REQUIREMENT:. :.:~..'~.~ ~. .. ... ~ .~ .. ~ ~
<br />:.. .
<br />NAME/TITLE PRINCIPAL EXECVTNE OFFICER I CERTIFY UNDER PENKTY OF lAW TNAT I HAVE PERSONALLY ExAMNfED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HERDN; MD BASED ON
<br /> MY INQUIRY OF TNOBE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOA
<br />
<br />W
<br />GOIT(]OII Peters .
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS
<br />~
<br />9 %0-8'~4-440
<br />97
<br />10
<br />. TRUE, ACCUMTE MO COMPLETE. 1 AM ALVME TNAT THERE ME
<br />SIGNIRCMT PENALTIES FOR 6UBMITTING FALSE INFORMATION
<br />INCLUDING
<br />P7: e51de Gt !Genrr~• 2ta:la f=r
<br />S ,
<br /> THE POSSIBILITY OF FINE MD IMPRISONMENT. SEE ld U.S.C. ! 1001 MQ D3 f10MATlME OF PRINORAL EXECUTIVE
<br /> U.S.C, E 1 ]16. lPMW6„ YWI UI,M .YWh. rtiY McAW (IMF y b S IO,ODO
<br />TYPED OR PRINTED A*sa'n,vwNnl MY/A+'P+r+l albnr,riemmM rg6ywF.1 OFFICER OR AUTNOR12ED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRet6t6nc6 all sttscnm6nLS n6rs1 '
<br />':ELTLPA•+L J. i,T•~^, t,TM!L" "1T -I :: Y~TYap ~)° >10T3,211iq apg~rn gYT.'MZ _ ~co s1.T"'tV+~'*'': TT"I1'ATT~X~ rf+;n~-•
<br />[.d.l.li, "-~~ Cf ~~ '?URP.`^I Of' °90;)'' i+'.?OTRF.ME:NTS 'iNOER L. A. 7. ~,rL c CovACP. - SZF. T. ?. I.(C). °F'. .~
<br />-'1':ITU`IIN ~. ~j!1 naT A,Y~'P.ACE 1!i HLG9E3T YON^9LT AYF:EAC^ i111Ri°C 7FgT'T~ Oo n(r4 TCn~
<br />EPA Fam 3320.1 108.961 Previous adition6 may be used. (REPLACES EPA FORM T~0 WHICN MAY NOT BE U6ED,) ~l19 ~ 7 / q 9 ~ U ~ 1 _7 (` ~ n PAGE • OF 1
<br />
|