|
PERMITTEE NAME/ADDRESS p.r>Va. ixWryNw/!ay)on U0l~n.r)
<br />NAME t,'vcnUV Fl,LLS LUALF IrVC•
<br />ADDRESS ~;~UTr;F ICLU %51 fJE
<br />l i,~ ~. JI:T:. rt ~J~4+L;.F ~ULTt
<br />L Anr_n:~UIJ LL.
<br />FACILITY LNL~L(rUCLS L.UALr 1..C.
<br />LOCATION}- L L„~ c la t L L
<br />ATIn JAML~ f. i:ULF'hk. Jt'-L.i'Eri
<br />NATIONAL POLLUTMT DISCNMOC EUMINATON SYBTEM JNPDESI
<br />OISCHARCFry MONITORING REPORT (DA~fRI
<br />1.161 17•!91
<br />4 r... ...
<br />y t J PERMIT NUMBER DISCHMOE NUMBER
<br />rsJ~ld'U4iiy MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />tlU~Lb FROM / J U TO 4 y
<br />A T 1 is N ~ 11471/ (17-231 !1<-161 !1617/ !18.291 130.31/
<br />Form Approved. r
<br />i ..h:. .-nU~.,; r.f~/i /' f Pf;19 LND.,,~o~O=DOef1f
<br />~ V ~ ~ ~ ` Approval ezpli~e OB-31~98
<br />1' - rl:r.:~ L~J4.-
<br />NOTE: Reed Instrvetlorle before eompletlnp thle form.
<br />PARAMETER 13 Cerd OnlYl QUANTITY OR LOADING I<Grd Only) QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE
<br /> 14653 ~ 15s-5V 38-<5 /<653 5L61
<br />(37•J71 EX MALY9s TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rss-e]1 (5<-5Bl l53-]Ol
<br />~h SAMPLE i•A•{L4{,a a}air #.if v4aaa# _
<br /> MEASUREMENT ~
<br />'
<br />..
<br />
<br />ILyJU 1 J l':
<br />`::.'.:"PE:RMIT:.:~:::
<br />;...#.~~!.!k:.:. ~..:
<br />.~~.:~•:q~~f~:.;
<br />#i.
<br />.'~~r.':::5.'..~~'ifir
<br />:~-<:~:$Tka:!~.d ~~~:.'.':~
<br />Y~~~r..::S :::::. :...:.:.~.;.::~ w.::
<br />::. ::. .. ..:.:.:...:. .
<br />~ .:~ x~
<br />:,,: .i.
<br />.
<br />_F-rJUL,+T v^;i i5 Y'ALl/L REDUIREMENT: ! #aa ': INZM uc' lit fS:: 1,
<br />~
<br />ELI LJJF ILT4L SAMPLE #>r4#,Fa i##~k0a #44### ~ .') ,
<br />L ~ r' L h U t_ L. - MEASUREMENT .. _._ _ ~ , ~..-
<br />
<br />~ - J
<br />f~
<br />}
<br />L'., .; J 1 ~ G ~.ii:'.h.ERMIT'` .. :.. 91. a~~!~IIvW~~'' %~:~:.i~l.~!$i+4S4~: ?1+~ #i. :: `;:: '... +F .........:..:: .__'
<br />.:.:
<br />~:
<br />
<br />~
<br />f
<br />
<br />,
<br />.JL, f .. u» ALUf. ..:EQUINF,MENT.: ><:~".: :. s:;ii~~~~`~~%.
<br />
<br />
<br />. ~ :.., ~.~~~.;:
<br />
<br />
<br />
<br />. fKa :«.~. :::::
<br />4'
<br />::
<br />_ 47 a~ I •
<br />
<br />
<br />r .: :I:.
<br />
<br />.t
<br />~
<br />I.L L+.~Jr ,~1iLEd~Li_ SAMPLE #a#444 #i V4#•t 4Fyae;. +/ ~ , ,
<br /> MEASUREMENT
<br />
<br />,;,,y~ 1 ,. u ::'PE MIT '.
<br />:.:..R .:.....:.
<br />' :.
<br />*.'~?~.~>t~:~;•:;:.:
<br />:
<br />;,•~~1.~~!:,b,.>~;
<br />{~,' ,.;,.:.. ..., ..:: ...:.:
<br />,...~*~a::...,:::;
<br />>
<br />':''F'a.~a[
<br />':
<br />'
<br />:::!+~t'!':4i2t:.::':. -
<br />
<br />~.:
<br />'~~la
<br />iki~ ::
<br />.I r~L,c PIT ., r:u~5 VAj.ut .
<br />itEt]UIRENIENT .
<br />..
<br />:: ~>-::::
<br />:. pa{F .
<br />M~'yr, .
<br />F
<br />.
<br />'"~ 'y.;F {}r<11. ~::: 4aR ~~ 1L/L ~ f1i.f:~lTH:~. .~. .
<br />:;~!•F TuTAL ~ SAMPLE il'~#4!•a 4##Aail# '1~#Vr* ly
<br />A ~ i-G MEASUREMENT ~ r)-~ ;., ) i ,tl 1/ ,I~
<br />:1<. r.. a +, (,` :. `. =~PERNi17`.:~:`.-.: .:~ '$ #':IO.~+h:.::. ~:.:#'R#.#:#Ilf k: as :: .~M'#r(: ~Ijr~::.~ ~~e7 .: ', :~~. l..Z~ - ., ,{L~L/ ~
<br />~ ~[4~
<br />~~
<br />_1 r~uCh~ UriJ$$ VAUTJC .(7EOUIREMENj; : :"."...~~. i.lr'~:~:.: r::~:.j:~: ~::~: ~. ~ #., .,. :.. ..~~ ~~~~ .: ~:.3uLI ~t1' AV~G.~ ~i3A1~ ~~.~l1#~'t~: v/L ~~ .
<br />PI~U~fi~::$= ..
<br />.::.:: ~... ~, '.
<br />,li. al, ~i :, .•(f:b+jt SAMPLE 4.:p}{.y r,. i. +P i+a+< ki•at•.':^ '%#'.'##ir .i 19
<br /> MEASUREMENT
<br />I~./~ '~~I rL
<br />Li-
<br />.~ -
<br />~-ilrli
<br />J,JC 1 L J .":'.'.:PERMLT)~:: ~:~ :~#.#Q'iriF.#yF~: :. ::.tl!84#111#~ 9: 4v :.:~~. irf~llta!fr lTri> .
<br />; .,:.:>Jt~; ..\<~tk~7~ .~.`::':..: ~:,:.
<br />
<br />t:
<br />;:' _
<br />t.:.
<br />i.... ~~;~,. .. ..
<br />hAL~
<br />.1-1 LL_~\f u~11~5 Y.LUc REOUIREfv1ENT` :' ;::. <' : v~"~ ,.
<br />:i: .:. '~ :<~::,?:.; ;. ~t'I~<::~AX~ G/L >. '~~riT
<br />L~ •r 1., ,.LNUI,f (JiK SAMPLE U3 'i'i#'k## 4i•-A{Fdy Y#4a##
<br />r-.u Tsui 1."_;JT r'LAI,T MEASUREMENT ~,G;~j~ ~'~~ f I/
<br />~
<br />:~..U:L, 1 u C PERMIT. :~~ ~f ,l'~i~T~.::j::: ., ~;:~::.,
<br />'c~{<"
<br />~ . .~~~:4+11~~!..:~!~~'::
<br />~ .4~~
<br />.?~?~C:~i~~
<br />~
<br />~~~~ ....
<br />?'~I!.!l!:+Ir?k~if
<br />~
<br />~.K• .#7 ~~ ~ti:a~'
<br />r
<br />
<br />' t
<br />_r•r ~l.ci,T ur.;,~., v41_ue
<br />REOUIREMENT~:
<br />~ ..
<br />3U~1A RV4' .
<br />.... ~ :.
<br />'~3~t..:1t:'.f11X:`
<br />
<br />uu ,
<br />:
<br />-. :n...
<br />.
<br />..
<br />:
<br />~ ~
<br />:~ ::.:.......:.: .
<br />,
<br />,
<br />....:
<br />...:.....:...:..
<br />
<br />#ap . .
<br />.
<br />:. ;. E1~ ~..t i_A~L SAMPLE •AP>?4ti•ct 'i4 .i ,j,p ..:r.,~ ~~r,. {.Ma# :. ,~!. rr i. ,t
<br />i ~u.+L MEASUREMENT }~ -•I I '
<br />~ -
<br />,yu~u 1 l 1r ~::~.PER.MIT .
<br />~:
<br />: *~#::
<br />~{' ~ ~ YTC LH ~ .Y J i ~W {1#~a#>P. ;F#i•$~6~d~ .~~~ :~ ~#a:a ~$w+e .P 3¢•?
<br />~`; ~
<br />
<br />•..
<br />;
<br />
<br />_t: LE, c.,.T uR.i :» ~r A.L'JE ..
<br />.. ....
<br />tREQULFiEMENT~: .
<br />~ .: .~~.: ~~: :~
<br />°~~nyi .~i:~jg,:.
<br />.i u
<br />~ -
<br />ti•t•?!•
<br />.~~
<br />..
<br />,.
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY Of
<br />AM FAMILIM WITH THE INFO lAW TNAT I HAVE PERSO
<br />RMATION SUBMITTED N NALLY E%AMINED MD
<br />EREIN; MD BARED ON TELEPHONE DATE
<br />
<br />_ r .. N I"i ~~~
<br />~`L~ MY INQURY OF TNOSE IN
<br />OBTAINING THE INFORMATION DIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />, 1 BELIEVE THE SUBMITTED INFORMATION IS
<br />
<br />-
<br />1
<br />~
<br />- TRUE, ACCUMTE MD COM
<br />9GNIFICMT PENALTIES FOR PLETE. I AM AWME THAT THERE ME
<br />SUBMITTING FALSE INFORMATION
<br />INCLWING ~
<br />„ ~
<br />~' Gp
<br />r
<br />
<br />THE POS51&LITY Of RNE MD ,
<br />IMPRISONMENT
<br />SEE 1e U
<br />S
<br />C
<br />f 1001 AND ]] I ` f 7 r
<br />~
<br />~ ~., -. r y S
<br />C
<br />E 1]10
<br />P
<br />V
<br />e .
<br />.
<br />.
<br />.
<br />f
<br />FIO
<br />ODO
<br />•
<br />A
<br />L SIONATUIIE OF PRINCIPAL EXECUTNE ~
<br />
<br />TYPED OR PRINTED
<br />.
<br />.
<br />. I
<br />.rW
<br />N.~ NNh. nLY
<br />ire. W ro
<br />,
<br />.
<br />r. V,IA
<br />Nr
<br />"r
<br />.,s e~nertxm.n tmiv/asrwnr or Mrv«n smarm Anse rrral
<br />OFFICER OR AUTHORED AGENT
<br />CODE _
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />uarmmcn I a nnu url.nrvn I Ivn yr nrv T vlvLq I Ivlvo rnererencs en srrecnmsnrs nsre/
<br />I ~.. ~ iL: T,>,L Tht.. L1`il:; HILL o_ n,.IY~Jf :+rL JLT fL.. ~i ..L_ JAL 1:,~ Li ii f .r: ~i_ ~ - r, •r, i ~._„!r' ~ .:.I_
<br />~~t LV!~uL:v .r I'r.,~u~' nC•v4.r(L~`Li\TJ u~1,.Lh i.a.3r ''. tom. ..ice .. ~, iM~L - .~_ . .. . _, r -
<br />_ ~ 4 •~ t 7
<br />v i . T ~ ~ : I T. I r
<br />EPA Form 3]20-1 108-951 Previous editions mey be used. ~ IR LACES FO M 4 HICN MAY NOT BE USED.) PAGE OF
<br />
|