PERMITTEE NAME/ADDRESS p+d4FsINryNwdLeearion!/pl~.wl
<br />NAME tlV Lrw ~~ I'Ilc T.S (, IJwT.r ~i i~~,+
<br />ADORESS~L:u111FItLi1 niNE
<br />i01 ~. IJA(Uiv uLVu. F Sl:l TL 4UL
<br />L ARi_'n :; l~L' (.u J113~Li4if9
<br />FACILITY CN[n.,Y f UCtS lL1PL r Ilrl.
<br />LoanoN~Lu~,crlCc ~U c~<Z6
<br />Ailiv JIi I~'.L~ T+ Lli 1, 1'C:c+ JI'-UF'tl{A )•T1i 1115
<br />1 ~ ~ .~
<br />NATIONAL POLLUTANT DISLNMOE ELMINATON BYETEM (NPOESI Form Approvsd.a ~ y,
<br />D16CFUtRGE MONITORING REPORT OMR1 ~ f~AB ~lo. 20.~O+A0004
<br />1-151 I7-YY91 ALU TI NET TC.5T Ii14 Jl+.
<br />r ., App'fovel ex vea 06-31-98
<br />ELI Lirt ]c I~~41
<br />PERMIT NUMBER DISCNMGE NUMBER ~. ~. I ~ r L ,
<br />.
<br />MONITORING PERIOD ~' I' ""'
<br />YEAR MO 'DAY YEAR MO DAY ~-,,.,~
<br />FROM ~ A TO '3:; i,o ~U #••+:' i+!_ .Ji ~(, riA~L,c akyf
<br />174711 l77-131 f7<-15/ r26-771 f18-19) r343r1 NOTE: Reid IrntructlaFU bHon GomplNlRp thle form.
<br />PARAMETER !3 Grd On/y QUANTITY OR LOADING
<br />~ 1<Grd Onlyl QUANTITY OR CONCENTRATION NQ. FREOUENLI' SAMPLE
<br /> l16-531 15451
<br />~ f3B-I5 1<653 ~ 151.51 OF
<br />l37-37/ EX ANALrsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rst-edi fs<-5Rl lSglOl
<br />-l.~_ ~Tdlrt:_ `+dlik :.c.U 'SAMPLE 4ir4$+r4 vOk#>a•x #R'4+F;.p .;.~Ky,tv.: ~; '
<br />C_,,IL,,,Arnf,id MEASUREMENT - ~ /1~Q ~rL.l cjrn~.
<br />dL ~,= 1. ~~ U 7.;:;2PERNIIT:j::'~ :'.':#o~''r;~( ..~..i ~: y,:..!iLlail~Y~ir1¢!y1.F'i~.:,}t 1". ,.....:":':::~:..:~:.~~:::.::. :'.::1iF ."iR~..::::':: :..,V~~L:~':::.',.:::..~, __F - ..: ~ .:
<br />- ~: r' s :REOUI9EMEN7:: :.....':~.......
<br />,.. ..
<br />
<br />~
<br />-C::~ ~TaTr~ 96nr, dCu SA.MPIE {rp.pyyf!. f4#p~pa
<br />4k##N~
<br />i-v•,. %e •, ;•
<br />~
<br /> MEASUREMENT _ r' ~
<br />
<br />d,.c~ i.
<br />l: v ~.x:XS.".F: RMhT`::;4.(
<br />
<br />"; l?pwx'''.:'.. ~".. .d. ~':..~.... .:.rTi''.:;`~
<br />
<br />Y:Pi
<br />.. .
<br />: '{~:-'~!~. '.~'?E".:..
<br />
<br />...i
<br />(.$
<br />~
<br />~!'.
<br />~ ~.. :. .. ;.;;~'::.;.;.
<br />}E
<br />`..
<br />~T
<br />"G
<br />y
<br />~
<br />'"" ':.:. ~'.: .:
<br />yy
<br />,~.~..M. T~
<br />.
<br />~
<br />: ,:n'~~
<br />
<br />'~:~,..~~'~~: .'~
<br />~ -
<br />
<br />~
<br />
<br />
<br />.
<br />
<br />
<br />.
<br />i~':w ;:~:
<br />
<br />
<br />. .
<br />'
<br />-~ ~
<br />J ~ VALU.. 'REQUIRE131ENT: .
<br />,.
<br />r... ... ..5
<br />:~~ ~. ,:~ ~~. w;:.. ~::;: ,
<br />:.~
<br />^:::: :
<br />...:....
<br />:c..y.y,. :.:
<br />:r
<br />.'i:..
<br />:.
<br />:
<br />:Ci
<br />::
<br />:'>.r'.: . ..
<br />.
<br />:
<br />~,,.t: ~:;:~:'.'::g.%~:'
<br />,,:'
<br />
<br />:'. .
<br /> '~ SAMPLE ~ '^'~~
<br /> MEASUREMENT
<br /> -,~:+r ....:PER,-~:~:";:
<br />sREQU1RE
<br />' :
<br />ME :~":; ,:- . ..
<br />,
<br />,
<br />:> ~:::
<br />•::
<br />: . ,....:::'..
<br />....,.... ..:.
<br />.
<br />.:
<br />..
<br />:
<br />:
<br />'- -
<br />.;
<br />~~'
<br />i:~~t~
<br />..:.'~
<br />.
<br /> .
<br />,. .
<br />.:
<br />.
<br />.
<br />: . ,
<br />,.
<br />.
<br />:.
<br />:
<br />. ~ .:.
<br />..... . ~
<br /> .' SAAAPIE' '
<br /> MEASUREMENT
<br /> ;.:
<br />'-
<br />;:... .
<br />'
<br />'
<br />
<br />.
<br /> EnLi! .' ME . ..
<br />.:
<br />,::..
<br />,:::
<br />,
<br />..
<br />
<br />.:::',. ~:.....
<br /> SAAAPL
<br /> MEASUREMENT
<br /> -~~..PERMIT..,~ ~
<br />~ ~ .
<br /> :REQUIREM.ENT~: ~ ~~; .,..::: :•. ~ ~~
<br />:. .. ~ .. .
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />
<br /> SAMPLE
<br /> MEASUREMENT -
<br /> _::. PERMIT:' ~..:
<br />:
<br />~ '
<br />~ ..
<br />~
<br /> ~REQIIIRENIENT':. ::..: .::
<br />,
<br />.. .~' .~
<br />~ .
<br />
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />MILIAR NRTN THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON TELEPHONE DATE
<br />_ II r..!
<br />~ / TLfL1TC -yL
<br />~ .i ~ 1::1
<br />/-, ~,_
<br />/r ;
<br />Mr INQUIRY OF TNOSE'INDIVIOUALS IMMEOIATELr RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFOPMATION 19
<br />~~ I
<br />__
<br />. TRUE. ACCURATE AMD COM0.Ef E. I AM AWARE THAT THERE ME
<br />$IGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INLLUOING :,J r `' - I f
<br />'y-"- -7 ;~-
<br />7
<br />
<br />~
<br />1
<br />~
<br />~ r
<br />~
<br />l i ,
<br />THE POSSIBILITY OF HNE AND IMPf1150NMENT
<br />SEE 10 U
<br />S
<br />! 100
<br />AND G3
<br />L " ~~ ~ . ~~ - /
<br />~ .
<br />~
<br />I i\ ~ / .
<br />.
<br />.
<br />.
<br />1 SIGNATURE OF PRINCIPAL E7(E ~ Z `~ ~
<br />~ -
<br />/ %
<br /> U.B.C. ! IGIB, rA,Wd++uM+r Nrw mruna mFV icAd~ r•,F+Nr ro 110,000 CUTIVE
<br />TYPED OR PRINTED And n,rr+i,x+n Mnpr/wmiv,t olMmw, BmmN+AMb y+v+l OFFlCER OR AUTNORfZED AOENi CODE NUMBER YEAR MO DAY
<br />
<br />.~c L.A..:r
<br />r~. `: F f:.:
<br />7r ~h. ..c L~ ur
<br />T T wL.t J.:n~~. nrr`I,nT
<br />~., -, u,_.. - .IT~;TIi(Iu::L. I•~_:.I -. ,;fi,:+Tc n'~ILr. I~
<br />~:.in~~ 1,, ?'I. ,.r Tt:.i :,ntr A;~: Sii~r :.i~J .iTld~-n .. (.U l~c T.I /,1l.l TY TLS( r,~~'.~:T f~-..• Tu ;Its
<br />.
<br />~ l: 'n L
<br />• qL
<br />
<br />, T I
<br />A . ,.
<br />. r T T. - r ,.
<br />. .. ,
<br />L-
<br />EPA Form 3320- 106-961 Previous aditionB mey be used. IREPLACEB EPA FORM T-40 WNICN MAY NOT BE USED.) PAGE OF
<br />
<br />
<br />
|