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PERMITTEE NAME/ADDRESS (GaYrLFmdgNa/lxrnm UD~.r..Q <br />NAME TEhILJiL ::~Et.Y ~~~! 6r{Y <br />ADDRESS TEiiitJH ~R3GR LOAUOUT <br />LBUO HIrHIIAi 133 <br />PAJNIA <br />,:D 81419 <br />FACILITY <br />LOCATON ~ FROM <br />A?TN: KELLY P9IPZLEdr !P°_t<AfL'J !IS RJR <br />._ ... iii=rel :.: t. U F t' : ~~ D T') <br />(~'i1Lik 'dC) <br />DISCHMGE NUMBER F - FI9AL <br />~s,,,,; --I H I N 0 R <br />Forrn Approved.n <br />N ~~QiM.0.20J4R.Q~OJ4~N <br />PProvel e~pl~p~05- 1-98 <br />t cnn my ~n• ~~ <br />U »06 i10 DISCHARGE vvvv~v fi~'~ <br />116171 (78-P31 (3631/ NO Mud in•trucrlaro ~bldor'•boRlpl•UnQ thi• form. <br />PARAMETER 13 Grd Onhl QUANTITY OR LOADI aa~ ' ~ <br />~ MGrd Onhl QUANTITY OR CONCENT I N 'ND~ FREWENCV SAMPLE <br /> !4653/ 151-6'II ' <br />-'T< ~ 138-451 !06531 15L5I1 <br />Ex' OF <br />TYPE <br />l3I-371 ~ ~ > ilNarss <br /> AVERAGE MAXIMUM TS MINIMUM AVERAGE MAXIMUM UNITS-~' jjZ.1]1 /1i4-581 /53701 <br /> SAMPLE fifififififi aOfiRa,'L :cr# ',Y. ( 12~ . <br /> <br />MEASUREMENT <br />~• • <br />00400 1 D J PERMIT ~ ~ ~ ~?»~A~?fi .~ :...:~#....1<LA!.R ,-,- <br />' .. <br />~ ##~#.*.:~~101 9•U 11L~T ~NS~ITU <br />FPLUENT JROiS VALJ^ .REQl11REMEN7 <br /> <br />~:...: . <br /> <br /> <br /> <br />. <br />~r... <br />1lAYidUM <br />SU <br /> <br /> <br />;: <br />x .. <br /> <br /> <br />: <br />...... ... .. . <br />ULIDS, T.7TAL SAMPLE aaxzxa abfiaac r. Orac»#~ ( 19) <br />U 5 P E N D E U MEASUREMENT ;~`;?^ <br />USJU 1 U J PERMIT rfi.fiA„p' ~!sA~3.,q<. ##fi Pt.xO.#-0~:.' <br />, 35 7Q <br />~ 'tlC.B/ :$AS <br />..PFLUENT '.iRO.iS VALJ S ;REQULRE.NIENT ~ ~~~ ._~.:-:~::!~..:.iy ».~Ytfi <br />. . <br />., ~ <br />Sun ., vG <br />:III. LY lwY <br />!fG/L <br />lf6ETH . <br />LI05r StTTLF..AiiLF.' SAMPLE ~+?rfifi fid0,#D :Oar4p4 alC:.t. #',: <br />( 251 <br /> MEASUREMENT ' <br />US4S 1 0 U PERMIT "kfifiGfi? ;kfi;rGGfi -r #','.~ fi#tiTfiiF# ##Or!Ot,: iP ft•.~ iP~P./. t$.AB <br />FFLUENf .:ROSS VALJE REQUIREMENT ... pAILY ~~ dL/L : •• MON4H <br />RONF TOTAL SAMPLE +;'kfir%•`• ..• ~ ::;:rr#~;- - '~ 14~ , <br />(qy F~) MEASUREMENT ' <br />1045 1 U D PERMIT %~'Y.fi:"- ~fifisax .r tg~.~C# 3.D b.0 "': `[(CE/ .SAN <br />,FFLUENT GROSS VALUE REQUIREMENT fiv~fi 30DA'^.YG DAILY ..".X "ia/L ~ <br />'. :~1081H <br />AND GREASE SAMPLE 4fi?fi.. rtR~'k::':: OOcfifiS;f fifi» #.^- ( 19'~ <br /> MEASUREMENT .. <br />,1591 1 0 D PERMIT' fifix.?.?~ Mfi4xF.4 ^ #Yfi II3tiLl'a# ###17;;.:10.. 1D e' ;bNtlk: RAB <br />FFLJENT GROSS YALOE ;NEnuiRENIENT »»;=a ''A"°~. >7AILY t!Y RG/L. :a: ~ 658t <br />UY~ H JR SAMPLE ( 03) fi?:++.-:F:= #'~# t`•;= {-"r;~## <br />HRU THEnTRBNT PLAVf MEASUREMENT <br />UOSU 1 0 O PERMIT PTI3'N^L REP08! s.paa#v #~# :>b ace#+t<,t#., R#3 ,: ~tSELY IfSTAt1 <br />PFLUENT ;;k(OSS YAI.iIE :FSEQUIREMENT ~ODA:~AVv DAILY 1111 NGU '' <br />~ d?#Ct , <br />• U SAMPLE #3fi fi fiP fib: #. <br />1<^ ( 9~ <br />I~SOLYEU MEASUREMENT '• <br /> <br />)Ut~S 1 U J .. <br />a EMIT <br />~ ., ...I .: am ~ ':# <br />r AEPCKT YBL~.:• RAA <br />FFLOENT uRASS VALUE . <br />gENIEN7 <br />REQU ~;.. { »7#fi <br />DALLY M <br />g R'G/L <br />.,.. <br /> . . ,.. : <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER ENN.TY OF l <br />/J•1 FAMILIM WITH THE INFO AW THAT I HAVE PERSO <br />RMATION SUBMITTED H NALLY EMMI <br />EREIN <br />MD BA NED MD <br />S D ON TELEPHQNE. DATE <br />' ; <br />MY INDUIRY OF7 THOSE INDINDUN.S IMMEDIATELY RESPONSIB LE fOR <br /> <br />OBTNNING THE I FORMATION, I BELIEVE THE SUBMITTED INFORM <br />ATION IS ~~ <br />'- <br />' <br /> TRUE. ACCUMT ' MD COMPLETE. I AM AWME THAT THE <br />SIONIRCMT PFN TIES FOR SUBMITTING FALSE INFORMATION <br />IN RE ME <br />CLUDING // <br />KELLY FRITZLER OPERATIONS MGR , <br />THE POSSIBILITY FNEMDIMPRISONMENT.SEEtBU.SC„C''IOO1MD33 ~ ~~ ~ <br />BIONATURE O INCIPAL E%ECUTNE 2 - 8 04 20 <br />TYPED OR PRINTED u.S.G. i tSt•. ' r utW dww mNhr m.F Nicwd. rxWlly ro 710,000 <br />•nl nnwimnr 'mrwrte/btwrxremonnu rM SYi••A) OFFICER AUSHORRED AGENT CODE HUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRelrrerrc• ell ettechments here/ <br />SETTLEABLE SOLCOS LIY.Ii APPLIES ONiS.[ IP C= 10-YR~ 1.4-iR PRc.:Ic ir.itil' lE-i CLAIRF,C. IF CLAI'f APPROVED OS = <br />YQCDr TSS G IkON LIMITS MILL NJT i.E APPLIs:i T] 'tEPOP.P?D ~1EA:iJbau~Nf:i--S E I.9.IA, PG 5 ARD I.P.•1D1 PG 6.% <br />STf1BMJ^TF'k gBNl1RN SNP Dr AY nU` T-1:-3R. ' <br />EPA Form 3320-1 108-95) Previous edibon• may be used. I (REPLACES EPA FORM 740 WHICH MAY NOT BE USE0.1 PAGE OF + <br />015 <br />191 <br />-- ==.y_...~_ - <br />