|
PERMITTEE NAME/ADDRESS B,.a•L Fr,4ryNsWL«anm UD/~E..v1
<br />NAME te, k. r, .:Yr - ~ j.vl.
<br />U~LS uJ.~Lr
<br />ADDRESS :n _,U T:II TCL~. ''1wL
<br />lu~~ o. u~:1 ~W „L~L.r :,ui lc 'r0u
<br />FACILITY ~ ~rLnUY FU:. L.`: (,!.•ALr 1'v :,.
<br />LOCATIONr."~, Irl„ ~~, :;UCLD
<br />AIT1. Ji+'c] T. L:J:iI'Lk. vi'-L,rntiA7li.N~
<br />NATIONAL POLLUTANT DISCNµOE ELMINATOM SY6TEM NPDESI
<br />DISCHARGE MONITORING REPORT /0 R)
<br />1-161 I7-19
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM yy Q4 ul TD /J ~lu Jv
<br />/16771 /77-131 /7476/ 176-171 718-791 134311
<br />~L,r.,: .-uir.. nr-.
<br />~VL : ~f_
<br />.•1 : • ...
<br />Form Approved.
<br />T oMp ~Iq. zoao-oooa
<br />Approvdl a>lpire• 0~531-98
<br />i,:,n ,
<br />NOTE: R••d In•truetion• b•1 • omPl•tiny thi• }orm.
<br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING f<Grd On/yl QUANTITY OR CONCENTRATION NO• fREOUENCY SAMPLE
<br /> !<6-53 /5461 I3B-461 06-53 /5451) EX
<br />137-371 µALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-eJl 164681 l6&701
<br />~h SAMPLE ;~.. +,riit• iir*84 vt :•G•t •tti L::
<br /> MEASUREMENT
<br />.04u.. ~ p ?:PERMIT.:..
<br />,.: ..:.. .. Ke*>}aln!!b ~4p'>P>kru i 'a;;. ~.s .: ..
<br />
<br />~ ~~~~f~ ...
<br />
<br />~ y.~:'
<br />%::` :
<br />> t.t;iiL.Yt CL:Ai:
<br />_rh W C. T uf, ~ .. .. :REQUI•IEMENT. : .: '. ~ ~ . ~ . ~:..: ~ ~ ' .,•..~ ..M I. .
<br />..
<br />.... .L. ,:-.
<br />LLlu~r I,.T~SL rd>r*ii¢ ii iii:< Pi+MiM4 I ~` '
<br /> MEASUREMENT - ~
<br />
<br />Jili3u i u C ~<.EMIT:~:::. ~~~:TROq+A}'#
<br />~~:~ Ji4$~diilc.?1r~ ~#
<br />~~:' •i .~~ ~~##YA~?
<br />Y4~~[F: ;: ~.: ~~Tl~`:~
<br />~ ~ ~~t
<br />l ~~~ :^31`~A~~•~
<br /> ~
<br />M .
<br />...
<br />:.. .
<br />;:
<br />~ . ~ :
<br />.
<br />- IRE
<br />ENY~
<br />~f,~EA . .
<br />:. ... .. ..
<br />: i.. f} .. .
<br />.H r.
<br />~LLiu~r ~LTTLtA_~Li_ SAMPLE pyip+ty ~ ViR•vFA•t VtA;•i•}# !•~
<br /> MEASUREMENT
<br /> ~~-~: ,ERki11T~~~<.::. :'~~~.~!!~i:..:....: ~.~:~r#$.w*a:~~r. ii :.:~ 8~:~,>ir~:~*'. -~~ ~~ P~~:~I:GNAL~~~~:' ~~~~~~.1;tE~P~i.h 7.:.:.. ~~~ L :v~LE~I~~~ [ a~:A~k~~
<br />
<br />EQUIRE .-.
<br />..
<br />.
<br />; .. ..
<br />~
<br />~ ~ ~
<br />;
<br />.. .:. :.
<br />~
<br />~
<br />- - ~
<br />_fFwL'.T uR 5s '1 AiUt . ..ENS::::
<br />>..:..;:,,.::.> :....... .
<br />.;
<br />...:. . . .:i?:'! r:.... ...
<br />, ~
<br />,. ...
<br />#E~i
<br />, . .,
<br />,,
<br />ird' n
<br />•a
<br />t~'ii• i<r .
<br />,
<br />
<br />JIL Atru vhEA$t SAMPL 44i#f•i= 4Bi44•t {•i4.4+A4 ~ Ali#iii
<br />iy
<br />RtL.w _ATrt-Li:AV r'SETN MEASUREMI:NT
<br />..UJ 70 1v ~~~~:: PER. 1.<.:~,-~::.
<br />.........,.. ~... .. .:.;.. ....
<br />>!.~'.'fTjl~!?~ :' :
<br />:. ':.a}#~$:~* .?(i
<br />~4
<br />'.' iE'iil'•!al'~14~.:
<br />rlc Y)Ak ~~!:'4.' . p
<br />~, 4:~:~ ..
<br />:
<br />1~1~7.t'11(
<br />.~~~
<br />
<br />FrLUL.rT ur,J~S YAtd= EQUiR M~ T
<br />`~.:;-w>::~=,..N;-
<br />.;-•'
<br />~;:.
<br />p'if
<br />fi•ES ..
<br />i.".h.T
<br />hufNr Iul Al SAMPLE 4A4+7 :•fi ti•4.PC•#Y •}ti<BYr N14
<br />1 t
<br /> MEASUREMENT
<br />,+~ rL
<br />~lu`r7 i (. 'U <:'~:7E:BAIT:F~~:'~:
<br />,, . ~Pd'~th.111:Rki~.:~.
<br />~ .: :.9p.>iral~49 k ?+• ''. #V.i'?A~'M~. ~..7~:. ~~ .:. 2'~~{l
<br />:.
<br />~ : yLt/.` .K~i1%":
<br />_~FLIi.`.hl anJ:iS YALUE ;f3E0UJRE{NEtyT: .
<br />.
<br />:.:: .:i;;`::+e:.5 :.';.:.. ':. r~l•i4
<br />
<br />~
<br />
<br />~ .
<br />.
<br />A MX.. ,/
<br />M ~: • ~, ! N~:•
<br />'iL i.h.1 ulitAJ>: ~5~: SAMPLE ~ a1[9tyJ~FYF ` 40it<*v •t~#•k# 9i4##4 1 :
<br /> Tv11FASURENIEN7
<br /> ~., : Trt~7 iNl k`i~i:.:..
<br />
<br />_FrLLtt.l Uk+USS VALUE
<br />RE¢tILR.EM~NT:
<br />.:.i;`.:.:`;~:~:~:;'~..::.,.rr ;;t,. ~.;,.:..:,
<br />:;':~;':'.j~...r.,, ~:::~
<br />iri
<br />....:, .
<br />
<br />,: .: :.. ..
<br />
<br />;.
<br />- ~..:~ :.:
<br />
<br />
<br />!..iEl~: .1`~'~~HAX~
<br />
<br />
<br />'U/L
<br />
<br />~
<br />
<br />
<br />ic3iT .:
<br />
<br />
<br />~::::.
<br />L Liwr I:. uLNr)U1T Ulc. SAMPLE- , UJ 0't z•+fr{ai {•A`VbYY -.i#4•:".•+•
<br />hnU TfILH TNttrT 1'LAlvT MEASUREMENT
<br />GuOG 1 U O '.;:~gER.M 1..'«d ~:~.:'~~t~E
<br />..E~:L~.:
<br />': R~Ij:..
<br />:?:~.~T?a~ ;::~~'~+N:!J!~MIR1k.~.:: ~?Ik'~::::
<br />::::•:,I'h~iF.?p'i..111 ::~.#~A?Y:K.~.a
<br />:.:r vV'• ~
<br />~' :KLY~: ~itiSTA~t.
<br />
<br />FFttLtiT uT~U55 YXL1J
<br />"BEqu1R ,
<br />,
<br />,::
<br />~jr-; ..
<br />,
<br />'•~~~: ~
<br />Gtt .
<br />
<br />~ .
<br />Y
<br />i~a~ . .
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICEII }CERTIFY . DER'PEI/ALTY OF lAW TNATI HAVE PERSONALLY E%AMINED AND . TELEPHONE DATE
<br /> AM fM11LIAq WITHTHE INFO RMATION SUEMIT7ED HEREIN; AND BASED ON
<br />' MY~ JNOU7RY OF THOSE INDINDUALS IMMEbIA7EE[[Y. RESPON9eLE FOR I
<br />
<br />~'/~.~ '~; %~. ~~LXY'1'i~Y(,J
<br />O•TAININQ THE INFORMATION, I BEUE1(E THE SU•MIT7 ED INFORMATION IS
<br />T
<br />OMP
<br />RE THAT THERE
<br />U
<br />'CURATE
<br />D
<br />ET
<br />P /
<br />_ ~
<br />~
<br />'
<br /> R
<br />E. AG
<br />µ
<br />.C
<br />L
<br />E. I AM AWA
<br />.E
<br />A
<br />SIONfNCANT PENALT7E3 FOR SUBMITTING FALSE INFORMATION, INCLUDING ~
<br />~
<br />' ~ * _
<br />-. /LG 7
<br />
<br />~~ .' _
<br />I <
<br />,_. T . r_ „I THE POSSIBRITY OF-RNE AND IMPRISONMFNT. SEE 16 U.S.C. 1 1001 AND 77 _
<br />_
<br />SIGNATURE OF PRINCIPAL EXECUTIVE 1 / - ~ ~ ~ ~ ~ - r
<br />_ u:s.c. E I a+6. rAwrd.. a•6.. dHr 0R/h. •••r McA,N n•N. ~ ro iuo,aoo
<br />-
<br />ER Op
<br />OFFI
<br />C
<br />E
<br />NUMBER'
<br />R
<br />TYPED OR PRINTEQ IR.n Ynprlaom•nT aFGMwn 6mmdw.,dsF...1
<br />warmu C
<br />AUTHORIZED AGENT DD YEA MO DAY
<br />COT.A ENTS AND EXPLANATION OF ANY VIOLATIONS !Rdr•ne• el! sttsanmsnn h•re1
<br />i5~~~ TL,T~L •LROk LiNIT~ i+[LL is r: 6AIVEJ. AtrL Si_TTLEaL,L~ oJLi.;~ LI:"iT AFr'LitJ r;,r 1~YKrcv,~. i'~...~1•' ~d_-.i-
<br />~L.c DuK.,cd l.F VnhUF hL'•tUI~CP:chi~ uhJL:K I.A.3F P. k;. ull L ~KL.ajt ~ ALL i.d.i.c. ~U uaY HVc~~..c 1,
<br />r ,. _ ,
<br />P or' 3320. 10 - PE gnui 'ilom mnY be v- CE5 F - ICH MAY NOT BE USED.1 d0otltl/9GO 31 O~U9Zi• PAGE 1 OF
<br />
|