|
<br />~ERMITTEE NAME/ADDRESS (Inrlude Faci4rv Name2araunn JDi$erev/ Np~
<br />VAME CUE.Ui(YO NAL COY P,?t1Y, L. P.
<br />ADDRESS~~, Low Y U MIN E
<br />5•/.il STATE NIGNYAY 13
<br />n;:EX~~N Co p16o1.
<br />FACILITY ~ '
<br />LOCATION
<br />FROM
<br />A rsN• -T_ 1,_ NeaunN r.~~. ael !re,•er ::.
<br />UTpNT DISCHARGE ELIMINATION B'ISTEM (NPOE3) FDrm AppfOVed.
<br />zA6 GE MONITORING REPORT (OMR; OMB No. 2040-0004
<br />9j
<br />~TaT nno • MINOR
<br />(SORB Approval expires 0537-98
<br />Nq)
<br />(NUMBER DISCHARGE NUMBER f` ~ F I N 11 E. ~ ~ ~' MO RAfi
<br />yyygMONITORING PERIOD~~ ~ ~ SEC 1C, pOND TO GOOD SpRINC ~CR
<br />MO' DAY ~ YEAR '.MO DAY
<br />Iu V1 TO~• .VU -:11 31 Qa:~ NU OI 4CHARG P. [zLl- dtie i+
<br />S~mni r9a-251 (26~P1)' fza-29) (3031/ NOTE: Read Instructions before completing this form.
<br /> (3 Card Onry) QUANTITY OR LOADING (4 Card Onry) QUANTITY OR CONCENTRATION NO'. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) ~:.z (38'45) (46-53) 54-61) EX OF TYPE
<br />(3237) AVERAGE MAXIMUM ~
<br />_
<br />ITS^::~ ;.:~ `MINIMUM "~ AVERAGE MAXIMUM UNITS
<br />(62871 aNALYS/S
<br />(64"6B)
<br />69-70
<br />FY. SAMPLE _;""...~-: Y en~F>!4 >4#4i!gC ( I2)
<br /> MEASUREMENT
<br />
<br />UU4UU 1 U U -PERMIT- - ~ 4141YpCSt' t f-,-
<br />_ L~= '~ b~= ~z~ ~ , >::`-,-:~
<br />~ f fi~KI+~ FNS I~L'
<br />L'E'FLUErlT GROSS YALUE REQUIREMENT .
<br />`+z
<br />~" r*'tt gig' ~ZY;~IIXl1'"'
<br />•~ :,U
<br />SC LI DS, TOTAL SAMPLE r. Ye; •"• ~- T~A,Cl:. ( 1~)
<br />S U S P t: LA D E D MEASUREMENT ,. rMliy' ~ r
<br />UUS3U 1 U U PERMIT .' #riAld~#'; ' y41 ~ ,
<br />~ a; ~ TiPN S .= C RC;$t .' r,8A9`, '
<br />EFFLUENT GROSS VALUE ^REQUIREMENT. --, _. _ ' '~ ~~.,,, r," ~.0. y. P>~~,.`~.: ~`.': "SC/L [(Y'I')!Y'.R 'I
<br />SOLIDS, SETTL£A6LF: SAMPLE °'F r•^"`~ r•:1arp-r ' ' cb4#Oy`." ( ~`)
<br /> MEASUREMENT
<br /> ~
<br />UU5U5 1 U U `PERMIT KT+3L'4~Q4.#. ,~[07XIPtgt~t rO Yf'rF tft'% .
<br />°, ;-"~ b~~.~" ~ i~~~
<br />EFFL~UP.NT :ROSS YALUe REQUIREMENT - - =- r'~r ~ •"`~3t, '~+~<~1~-i ML/L = d._ Md21'1R.~ '. -
<br />1XU1t, ?OTAL SAMPLE ~`u:•:`:g:: •.. *R,'rlnt?.1}.;, ~: ~ ( 19)
<br />(A S F E) MEASUREMENT ~
<br />:' "` '
<br />UIUU`_, 1 U U • ~ PERMIT- -'PIDFIIik?q)r", '""sY3PllrMt#~"`X~ :;,::1:' ,
<br />,
<br />iRt~- ~"`','~','~P ~~~ ~~~$"''
<br />c,FFLiIEhT uN05$ YALUf `REOUIREMENT
<br />~
<br />VIL ANC CkEAS£ SAMPLE i:=l"max''' ~:~'::~}.^. a`.tj{<+.AI•:LY c~ra~;aa` ( 19)
<br /> MEASUREMENT ;?y„ •'
<br />U J 5 d 1 1 0 0 :PERMIT
<br />` ~p+PTtrOI'4~r iF~AylBfr " 17 " Til~`I¢ `~-7M 'I:' ~i~`:~.
<br />a
<br />AFFLUENT ':RpS$ VALUE .
<br />.
<br />,
<br />REQUIREMENT
<br />r.~... ..
<br />~ ~
<br />
<br />,'
<br />
<br />'. ~+. =^ <
<br />w`;,~~, ~ MG/L 1 't~`t-~~
<br />FLOW
<br />F N CONDUIT OR SAMPLE ( ~r3) r~~?+'s:`•;v4 fi4R##~r ~~~~ 4l?t4
<br />,
<br />NT PLA97
<br />T`!'!U TNt:aT:"
<br />F
<br />MEASUREMENT
<br />~~ .
<br />,
<br />.
<br />hUU7U 1 U U t PERMIT ~~~~ ~ ~~~~QR 4:'-~~ibn~,,I
<br />r
<br />~
<br />~ ~
<br />~ 40ri t~`~Y~,,_
<br />:
<br />t: F F L U !!' f: T' f,• N O:; 5 V A L U k REQUIREMENT.
<br />... 3AD# ;I~ ° I}•,AI'LtT ~~'~ "O D .;~ t
<br />+ `
<br />`, . tMl~.AO . two . 1 ^. !''"
<br />SOLIDS, 2 ~'FAL SAMPLE 'X n;::::1:` nxt:t:+',-t i<tt4V:7h :~-'19)
<br />n I 55 O L V tti U MEASUREMENT - P
<br />I d 1) 7 1 U 0 9r~sX +F~c~q#91t}It R t~ ,:' t7f? #r+~ti s: ~.~ "`.
<br />- "~ ~* ~ `
<br />"
<br />"~
<br />..FFLUE4T GP.OSS VALUE REQUIREMENT,-~ ~";:n= ~ nr'~a' n~ ~"-`~~~~ ~'" ~!!G/L
<br />v ~~~~
<br />ANO r ~ TELEPHONE'
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERrIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED
<br />AM FAMILIAR WIRi THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV ` DATE
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />/~
<br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, '
<br />ACCUMTE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE ,..
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1e U.S C 4 1001 AND 33 U S.C. SIGNATURE OF PRINCIPAL EXECUTIVE I lr) ~ 2 ~I- /~. 1
<br />h
<br />
<br />~• ~ /~ I I L
<br />I nt n. ~ 000 entl or
<br />inclutle lines u
<br />to 310
<br />untl
<br />a statutes ma
<br />Po
<br />tti
<br />M
<br />4 tat e AR
<br />
<br />TYPED OR PRINTED ,
<br />y
<br />p
<br />ne
<br />as
<br />er
<br />es
<br />. (
<br />maximum impnsonmom of between fi montrts entl 5 years.) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />GUI~MtN 15 ANU tAYLANAIIVrv VF ArvT VIULHIIVrvO (nalaronce au auaonuronm ua,n/
<br />ScTTL6~eLE: SOLIDS LI!!IF AF'PLItS Ci.LY It' <=10Y8, Z4HR PReCIP F.YENT IS CLAIttSD. iF CLAI(k~lD~RC1YED PT N~C[i,
<br />TS$ L IRON LIMITS 4ILL NOT Elf APPLIED TO REPORTED P2ASL'REtl£NTS - SEE I.F. 2, PG. 5 ~Q]14EN OF PROOE'
<br />, r !•~ -..isw •y4, • °• PAGE OF
<br />-EPA, Form 93261 (OB-95) Previous editions may not he usetl ~ ` (REPLACES EPA FORM T=40 WNIC_N~MAY NOT BEiUSED:)~, .,{t~M~~^
<br />
|