|
ADERESS IJLF.iL(tAll/~i i1 LL L175.1. 1ll~tl~~.ll.Ui!lL.L-
<br />- - O.N ~ EA S.T ~iil. Y-611!(E.E ~ ThE~'J_ _ _ _ _
<br />_,sae~.ssuLE______~i~s~i
<br />FACILITY .= , [r
<br />LOCATION_-_ ~-_---~ -----___
<br />A4TNe nAVTn' a necnnnc:-I.r._ esn_ `• ~'
<br />.r ,
<br />PERMIT NUMBER
<br />;, = ~ MONITORING PERIOD
<br />= - YEAR- MO 'DAY ~ YEAR MO DAY
<br />~.FROItI .. !, 70 ,~
<br />J -- . ~r
<br />-! F I70:71Yi /71431 x/71-7J1: ~ " ' /16771 QA-791 /30.311
<br />EI'! ii CSI.driG !0 G6ASSY C6cEh
<br />NOV 0 4 1991
<br />!; ~. ,. L-,. ..
<br />eIHOR ~suea:YY):R~ed~and
<br />NOTE: peed Irotructlone belore co ~]Igs(1)jtyp,,;__
<br />~! (J CaMOnIyJ QUANTITY OR LOADING ;c~[
<br />~
<br />~' '(1 Cald Onlyl„ QUALITY OR CONCENTRATION l' -
<br />I
<br />I '
<br />i+ ~
<br />-
<br />~~
<br />NOf
<br />FREQUENCY
<br />SAMPLE
<br />PARAMETER /16J31
<br />Y 111fi/J i+ ~'! L
<br />- _
<br />/1613) /JI-0//
<br />(38~J1'
<br />E% OF
<br />(31-371 ~ - AVERAGE ~ ~ MAXIMUM; UNITS,: ~ MINIMUM AVERAGE MAXIMUM ,UNITS ' =~NALY515 69-701
<br />
<br />FH '' ^ SAMPLE ~##~~#I
<br />
<br />:
<br />. ti ######J
<br />
<br />p ~ ~ V r \ ~ '-I###'t~,~
<br />i
<br />i I - •'
<br />' ~ ... ~
<br />;T
<br />J MEASUREMENT . L
<br />l ~
<br />t9
<br />r7
<br />~ n" -
<br />N -
<br />- -
<br />/ v
<br />~ .. .~
<br />J ll
<br />'
<br />00400 1 0 r,0 -~ ~ PERMIT ~. ~~####'~ Q "
<br />~ ~' 1
<br />„
<br />?j~~ . ;
<br />~ ##~ _; ~''
<br />'6.5-. ; ~a
<br />~ x
<br />~.~~#~~#
<br />A.0
<br />r ' _
<br />~
<br />~
<br />~
<br />'
<br />.KGB/
<br />~
<br />aee
<br /> ~EOUIREM~NT .v .» '~, t~ t ,
<br />~
<br />"i,, 'I #~##` ~.. ~ ~ - `
<br />'
<br />'
<br />SOLIDS, SETTLEABLE; SAMPLE ######_ "-'##3###~ y ;- I ~~ ###.~## ###### I ~ ;',- ? ~. ~ ~; ;' '
<br />t [j
<br />n MEASUREMENT •~ ~ ;) r7 4~ i, _ ~' ~ T n
<br />OOS4S 1 O' ~r O •: PERMIT u
<br />' ####~# 13#####
<br />#
<br />' ### --~' (~.'~~#~## ~ 'T###~>~# Q.!~ ~ - ~ ~ YCBI•' alB
<br /> REQUIREMENT,: - iR s ~
<br />c
<br />~~.'f.' ~~~ W'Q ###~. i.,~' ~q.
<br />• _
<br />.~- 7:'r;~ z ~ Y ' ,
<br />'~ a I
<br />GIL AYD GAEASE SAMPLE '#t'F#### ##,^~i#~#~ ~ "-.
<br />#v####' ~ ###### ~~' - •. .^ v
<br />F6EON EYTH-GAAVp BET MEASUREMENT ~ r' ~ :. ?~ 3 '~• ~ {, `+'
<br />n I
<br />00556 1 ^ O,' -'0 ' J PERMIT.
<br />~ ql~###?~ ~
<br />~
<br />~ #>~# p. {'~#;R rk### ~
<br />~~~ ##t~>¢~k .
<br />~
<br />- .1~ i ~ ~ .OYTIB .,,II
<br />AAB
<br /> REOU(FEM~IIT
<br />: ~
<br />^J
<br />LF} ####r
<br />+_ tV
<br />7 •~ ~
<br />N 4. a'
<br />..
<br />~l._ i I
<br />1
<br />w 1
<br />IRON =' ~ ~ SAMPLE
<br />` ###+}?01#. ######.I
<br />O ^+ a• .T'####+~#. ###### (yl
<br />I - .~
<br />• ~ I
<br />
<br />TGTAL BECGVERABLE ~ MEASUREMENT -~
<br />"' _
<br />- ~ '~ a :~ ~
<br />, -
<br />`` ~ - r I~
<br />- -
<br />~
<br />- '.- 'i c; ~: -
<br />~ -
<br />00980 1 ` 0 ~'0 ,-"' _ PERMn
<br />OUIREM
<br />NT ##### _
<br />~ ~ # ## o
<br />### ~y¢{##>~j.#4# #~#Q+O!# ~;
<br />~ ,OP•~IOY L
<br />~ ; D.
<br />~ 6F ()Y2I[
<br />~ HIAB
<br />I FE
<br />E a` ~ ~ ~~'F. ##l ;:'C. ~~ ~ ~ ,. "'C~
<br />ti " ,
<br />FLOW, IN
<br />CONDUIT OR M
<br />,- "'######' ',. ;~;`'. J 49 . ~ ,
<br />~####'•[I! .:###### ~ ;##',k### ', ;'
<br />F
<br />THRU TREATdERT `PLAY EASUREMENT - ~ ~ ~ ~ -' ~ ~"
<br />50050 1 ..'0 :~0 Y PEeMrf
<br />' .?#~#>~~~
<br />K`
<br />~ : ~t PDB~ J ~ rJ ~#~## ~ FS~#~ #`r;, i .11#>##~
<br />~ ### ~} 11C8/ YSTAY
<br />~ " a
<br />REOUIREMENT ~ h
<br />,
<br />"~ q ~ ;y,
<br />.~
<br />SOLIDS, TOTAL' SAMPLE ., •.. ####~# . ,##'##?a#' o ~ ~ :######
<br />' ',~ ~##### ~ :; " ~_ .-
<br />DISSOLVED "i MEASUREMENT .- ) ~ A -~ A ~ , ,.v ~ :
<br />I '
<br />~ ~_ _ I - ~
<br /> ~ ` ""
<br />70295 1 - 0 -,0 l; PERMit,
<br />iEM NTC
<br />fi
<br />OU Y#~#~y# I; ~#~ #~# #t!0# ~,
<br />'
<br />~ 0`~'1QI#,x
<br />'IR_~
<br />' ' $$POei Y ~ ~ T$I.Y $AE
<br /> ~
<br />~ ~'?t,{c~: „~ ~'~r' X
<br />.t
<br />"~ ^. ~4
<br />~ ~ ~ ...+ f
<br />GIL AYD GREASE ' ~ ~ SAMPLE
<br />' .#'~I##~#'
<br />t .O a• ~' ~' Y
<br />`
<br />~ 'I. ~. L
<br />'~
<br />V ~ ~= ~~####~ C•• #~~### ###### '' ''
<br />L -
<br />H - '
<br />v - ._ c!. ! i
<br />E MEASUREMENT ~. .- i ~ ~ .~! i
<br />,y ~
<br />l - .~ ~ .1 •? I ~
<br />1.:, 0 r0 r '
<br />84066 .~ PERMR'
<br />' c#~#~#3r r o~- ~~'
<br />~ 'ES=1 '+~##~I#~# ~ ~ `~'
<br />tl ~~~~ 1 ####~ a#.~ ### ,: ~ v Yc$/ isoaL
<br /> NEOUIREMENT
<br />.- _ YZ ~ *:
<br />' i! .~. =R .a ~,'' j N
<br />R E ~ ~ S ~`
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER.- I CERTIFY UNDER PENALTY:OF LAW .THAT I HAVE:P
<br />AND AM FAMILIAR WITH
<br />THE INFORMATION SUBMITT ERSONALLY E
<br />ED HEREIN
<br />A XAMINED
<br />ND BASED - ~
<br />~
<br />- f~ -~TELEPNONE DATE
<br />ii a
<br />~ ~
<br />ON MY INQUIRY OF THOSE INDIVIDUALS~IMMEOIAT ;
<br />ELY~gESPONSIBLE F t
<br />~
<br />~r ~;
<br />l `
<br />// ~ /J r
<br />C
<br />I
<br />~
<br />UCIC ~-
<br />Kara
<br />N
<br />Rd
<br />^ OBTAINING THE INFORMATION. 1 BELIEVE THE SUB MITTED INFORMATIO ,
<br />~r
<br />q
<br />/r
<br />{r
<br />~
<br />/
<br />r=/
<br />//
<br />(
<br />[
<br />/ I _
<br />/t
<br />•
<br />.
<br />U
<br />- IS TRUE, ACCURATE AND COMPLETE :I AM AWARE THAT TMEAE^ARE SIG ~
<br />1/
<br />/
<br />~/
<br />~
<br />' '/
<br />//
<br />~
<br />1
<br />r-
<br />'
<br />~'
<br />~
<br />'
<br />VTC2 PI'eST dent 1
<br />`' 'NIFIGANT PENALTIES FOR SUBMITTING `FALSE~INFORMATION, INCLUDING
<br />.THE POSSIBILITY OF FINE AND IMPRISONMENTe~SEE~IS:U.S.C,:1 ~1W1 AND
<br />J3 U
<br />C
<br />1J1B
<br />Pr
<br />fa
<br />h
<br />B
<br />d
<br />Ad
<br />d
<br />l
<br />f10
<br />0
<br />0 I NATURE OF PRINCIPAL EXECUTIVE 608 754-2291 ~1 ~ 10 31
<br />
<br />' TYPED OR PRINTED ~ na
<br />u Pn
<br />r
<br />.
<br />.
<br />. 1
<br />. (
<br />n lr
<br />j+nrale may/Nt
<br />.
<br />0
<br />,
<br />6y
<br />n¢aP,lo
<br />aneor manmam lmpkonmrm oJbrrveenemonrhsand fyran./ L,
<br />OFFICER~OR AUTHORIZED AGENT
<br />~MUNBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTAND E%PLANATION OF ANY VIOLATIONS (Rrfercna allalmchmrntt hrre/ ". '-' -' I '
<br />GIL E GREASE: SEE FOOTNOTE F/, PAGE 3 IN'TRE PERtlIT. FOAtlERLY DISCReRGED UYDEA CO-0035653. .
<br />DISCHARGE NUMBER
<br />(REPLACES EPA FORM T-ra WHICH MAY NOT BE USED) PAGE OF
<br />IIOI'21/970723-1557 7
<br />
|