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~ TEE NAME/ADDRESS p+~.nednyvwtorrlel.¢p~ie~r)_,.! - _ _ ~_. _ ~ ... ~ ~ .:. _ - .~ F_orm A proved. POYDERROBN COIL ~~ ss ROADSIDE [!IYE, COllPll[T' N E S PUR'lALS ,_ "° D - 0000 7 ' r ~ HO1D328R C3N TO'~C - (SUaR YC) PProve a p ee, -31-98 ~ rn P. 0. 60 Y 1 U 3 C PERMIT NUMBER DISCHMGE NUMBER F- F I p A L ~ =°i PALIS.4UC CO tl1526 NINCR Y MONITORING PERIOD YEAR MO DAY YEAR MO DAY ~ ION FROM Ul TO 1 S :#r HO DISC'IARGE ~ ( # : 7 J G :: n A: M C A A B, P k E S I U e: A T !74211 l77-131 !7675/ 176-?71 118-Y91 !343/1 ~ NOTE: Rud Inetructlar before completlnp this form. PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Card Onlrl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE 146-531 154811 138J51 H653 /54871 EX ~ TYPE !37.371 µ Ty~S AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM .UNITS l67-e]I !84881 168-701 :':1 SAMPLE :4`~;F=+;=:k #::r#%Y~`J ~#:':#IRC p q 8 ( I2) ~ / / MEASUREMENT (/!5 A f ~ [~~ vUUOU I U U "PERMIT .. L'',"Ft'-'C+## ~3#zf tT# SY:# 6iS #7CK##~ 9.0 .. L74KI.Y ~N.~~IP r.FFLUENT GROSS YALU .REQUIREMENT, ~~ ~ ~~- #### l11.pIliilfl: .. A 4l R - JLILIU5, TU?AL SAMPLE #11###:: ",/##### ###t## ~ ~ ~9) ~ /~ ~.'J S P$ h U E U MEASUREMENT ~~ 3US3U 1 0 U ~'::?::PERMIT.~.~;. ~ ;'ti ~ /kt[#;:,:~ ::;-iRICiA#~Il~.~: ir#? .,~6.#.#~'+R#r~~~::~ : :35:." ~:~~:>.~:~,:~: .:~'a ... .. pC~'/ ~ 1-8 r.FFLUENT CROSS VALU ,:R..EQUIREMENT. . -:.. ~.. .: ~.... ~...~ . .:.. ; 30DA Y6 't.T:. G ~ ;. idOY, TOT .L SAMPLE ~%##### 4####? #####+ A p 19 { ' / (A$ FE) MEASUREMENT ^ ~ ~.CJ"l' ~i 40 ~ V (~ ~, J1J4S 1' 0 U PERMIT #aT####. :#ys;,3C0 #r;L Ctpgm## 3.5 9;0. NCEJ. ;Rlr3 cFf.,UENT 'CROSS VALJ REQUIREMENT #;;:::1 3008 AYG D.A T tlZ G/L ~ N N H .:IL airD RBASF. SAMPLE t.~;t'-:::g C~#L~:. .t D':#'};~ ./ "~ '/ / ( ~9) / / MEASUREMENT / ~a! ~ ,(~ ~ ~/ ~, 1~b2 1 ,0' /) PERMIT ~`~+'~RYr #Rt###~' +r ir+P#*h#< REYOli2 LE) "GItTIN .RAB cFFLUENT ~~QS.`i Vp LJ~ REQUIREMENT ;: its 34DA 11VG INS.1 S!AX `fG L E;ENT FLU>r, Ih r. UUIT Uif SAMPLE ' ( ,)3) ##Z':'*F~ C.##C~t ;:: ~`t,Y'vY ~~yy(( i i:1=tU TREATK$NT ~LkN MEASUREMENT QlQ3~ Q,Q85 S~/ 1 ~, ,UUSU 1 Q 0 PERMIT R1:PJRT KE2gRT ',k #44"-Sk'+ rL~L"lfY3n ~A$#~#v : '#tr# $f^r{LY ,4f $'}~'AN cFFLUENT GROSS VALUE `REQUIREMENT 3UUA AYG ~~ITkILB~ !7X MGD ~ ##L'# SO S! TOTAL SAMPLE +:<t #;: ~.`, 4: .~?~=#: ri##rk ~' ' ~ ~ ~ 19~ ~ 1IS$OLY GU MEASUREMENT ~~ ~ 8~ ~ 2 lU2`JS i 0 C PERMIT tr>:L#ae#= r&#### >z;„: ix#fi0~? RE I(3 RS R$'<GRT ITRLY ;RAS Cr'FLUENT GROSS YBLUr REQUIREMENT ~ ~ #+,## ~~ QRTF..A:YG. ~ -RTF !!AX dG/L :. AND C: EA ?' SAMPLE •~:+.•+r# ( 94) ##Y### ',:A###: ~St~t ~#G /~ VISUAL MEASUREMENT ~ ~~ ,4JQ6 1 U U PERMIT -..~' .~=~~ R,EPOF. Y ES=1 #~###r ~# ~4>r =>;#K~#=x ~ #rY 2~iiLX TSUAL :.t FLUENT GROSS VALUE REQUIREMENT. ~, ~~ : .I~Dt~S'3 riAX.` N0=0 ~ ~ ~ ~ ##ca NAME7TITLE PRINCIPAL EXECUTNE OFFICER -I,cERTIFr UNDER PENUTr DF Iww THAT I HAVE PEnsoNULV ExAMINFD AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE J ~ ~C~ MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTNNINO THE INFORMATION, I BELEVE THE SUBMITTED INFORMATION IS _ , , I AM AWME THAT THERE A11E TRUE ACCURATE MID COMPLETE , . SIONIRCANT PENALTIES FOR 9UBMITTINO FALSE INFORMATION INCLUDING FS 4/~~ , E t E - Z~ ®Q / E ~) ( p01 AND ]] THE POSSIeIUTY OF RNE AND IMPIIISONMENT. S E t8 U.S.C. BIOHATURE OF PRINCIPAL E%ECUME U.S.C. ! t ~tP. eMW14a Wr ewe Futuna nrr Nrhw !w. y ro !!0,000 AREA TYPED OR PRINTm Fnd a.nu.imFn Ynylaumnnr F/MMFrremmNFWet'r•'Fl OFFICER OR AUTHOp12ED AOENT CODE NUMBER YEAR MO DAy J a COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Referents e!/ enecnmen/s here/ TiISS OUTFACE IS NO'T FLIGIdLi3 FU3 dXEMYTION:: FROi1 TL7TAL S75PSNDCC SOLI CS (TSS), TUTAL IRON AtIC/OR ~d'fTL~AttLE SOLIDS LINiTA'fIONS - SEE I.A. 2. EPA Form 3320-1 108-96) Previous editions mey be used. (REPLACES EPA FORM T~LO WNICM MAY NOT BE UBED.1 D 0 31 u / 9 A t 2 2 3-125 6 PAGE IOF