|
PERMITTEE NAME/ADDRESS pnchrde Pnc(liry h'mwl[acnnon iJOi$ereny
<br />NAME CYP-itl: '~!•.'ID~. v~LT..., .. .r ^1v P,
<br />ADDRESSM III ES 1, 2`;~ °~'nT^'~-, "I•-e~l a:;
<br />9100 ?a^.. "T'J'P'1 _'."`L~
<br />FNGLEMnnn ^~ ;nlr•-;
<br />FACILRY
<br />LOCATION
<br />~03RT5 '0~.. ", " IRL R""T
<br />NATIONAL POLLUTAM DISCHARGE EOMINATION SYSTEM (NPDES) FGTm ApprOVed.
<br />DISCHARGE MONITORING REPORT (OMR~ OMB No. 2040-0004
<br />(z Is) nr~ 9) ~ ~' ~ ' ~ Approval expires OS-31-98
<br />PERMIT NUMBER DISCHARGE NUMBER ~ _ c r •• + r ,~ ~ ~l ^•
<br />MONITORING PERIOD " r; '~ ~ r n n •; ~. n +rT y T ~ ~ T, ^^- r c v
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 'a I,e TO ~` 1 ... n !bgr ... n • q/-v ~ nr'G' ~ s':h':
<br />liazl) Izz-za) fz4.z5) (zaz>') Lze-zv) t3oa1) NOTE: Reed InsVucNons be cortY2leting this form.
<br /> (3 Card Ony) GUANTITY OR LOADING (4 Card Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 46-53) 54-61 (3845 46'-53) 54-61 F,C OF TYPE
<br />~~~) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />rszm) ~a-rfls
<br />64-68
<br />69-70
<br />;,~LI'•t,UCT.IY[^v SAMPLE :x#".eRX:X rt:,.,..;.. ~r;r«....... ( T1~
<br /> MEASUREMENT
<br />.l U'2YI. ~l l! ~ PERMIT -.O+Or mIQ4 ~!' ., ~.~~,.~.., ~. :,.. ._;R4d4!@r?!'.
<br />~ R~~:t)~T ~
<br />:..: P?}'tl.~l-~; `~ Yvn / Q 'L'~,'X'
<br />31 `R.~:~Iy~r
<br />i P~LIJ ;';+' ':N~e~ Y><Lgf -REQUIREMENT ;',~ = w.r- ~~y r,R - : ~: w ,
<br />Vrf SAMPLE ?CRR 60 Rx R•r, .~ h±~$:/h ( +~)
<br /> MEASUREMENT
<br />CU4UU l ~ n
<br />' `.PERMIT "„ ` ~?~ ; y.j QlR9LR+Ce;-`
<br />` RrY r: r ~ Y, +~.. e,r
<br />~
<br />'FFLtJt:":
<br />T GR~Tg P`,L'L~ ~REOUIREMENT -,'
<br />f ~+}hr H ~ ~~~1,`~~t ~'1 $"s,. ..
<br />,ULID :, ~°_T*L° q ~! " SAMPLE RS: r:+RR FG:f~R.Y .,.. ,. «.... f ^S~
<br /> MEASUREMENT
<br />rn5v'; P D ~ d ~, aaQ~.yfx ~°^'~ aaa ; PoaT Rsp~pg~' ~# I! „
<br />s- conneRr~ R- _i, PE4 ~
<br />~ >••~RR ~ ~ ~a, tIRI~R ~z ~, ~r ~ s~~ .
<br /> ,
<br />_. _
<br />~ ,; • -
<br />,L;LiD~~ SETTL°"'~' SAMPLE 'rJ RR;::•(: RRtRRR 9 ~kwxr~ f
<br />^~l
<br /> MEASUREMENT
<br />O J51J 1 D 0
<br />:.:PERMIT ~ 4' NOr OeRCIL`. /: ";: .Ri-OR "
<br />RPP~1f'1~~. ~ '~
<br />-
<br />~'S
<br />~
<br />TJ
<br />~.
<br />kC#'` :T
<br />'FFLU£tiT ~RD55 Ve I.lit REQUIREMENT 4 ~ - C~~^ - jt) ~ ..
<br />nfr~T
<br />kE .r ~• ..
<br />y -
<br />:1jL F '.; 2Ep5t SAMPLE RL`'XR RR ny ?:: o:y r,... ,. ,~~ r^C#••, ( T.T\
<br />l
<br /> MEASUREMENT
<br />u" 0 i5 ri 1 0 :1 PERMIT -0r#ITR#0 CCI'+Of#RR.. :•,... AMdC~r~r-; ... R~r9rR ~ ' io- ~
<br />. ~ !f~"T"~1 ~ 4
<br />,."'f.gEuT ~P^' Y4LrG GUIREMENT ~ •,•at'k ~.
<br />rr _
<br />
<br />t
<br />S~'S!~; ' Mrr/1. ,
<br />~,
<br />"'~ aqT r#*++,
<br />s
<br />"L17:~, tl C7yf :I~* JT: SAMPLE ( Uj) q,}trthn ry.~..... tbt^.ax
<br />''i : I,' T R ~ A T!I S N T a L A ~' MEASUREMENT
<br />X005 0 1 D ? ~~ ~RrAIIt .,
<br />~ ' .$ P ~
<br />- ~ ~ t'
<br />_ ` ~, .,. a!Y`. ~ .#Ik~~r!€r~i
<br />,r ~ ~
<br />~ * r.>`
<br />,'".~
<br />~'>?`ILL.~_
<br />
<br />~~ ~ r L U E N 7 1. R ? S ; V T [ ' T
<br />UINEMENT
<br />AE 4611 ~~ ;P11'C T : -.
<br />
<br />^n
<br />
<br />ar>
<br />
<br />
<br />~
<br />
<br />
<br />~
<br />.
<br />
<br />;~';
<br />-
<br />l:L AMD ;!t~.'~ ;% SAMPLE .A~htRr ( '19) ,~.y.~.. r.., x;:...x..A ': is ~-r:y-~
<br />Y Z :: iJ P L MEASUREMENT
<br />:!IOFrb 1 ~ 'J PERMIT ~O1914t0( ~- "~ Fi=i °' -O:p'~AOIR . :: ,prig#IRKr# '~ a#l6ifl~t't#.'* r': f~ " 11 ~. ~((L'T
<br />_z~r•[.uev. r;r.~;~ ,t,t•s. REQUIREMENT 1~$!' Fl~~ '.'1=~ r,~.
<br />NAME/TRLE PRINCIPAL IXECUiNE OFFICEfl I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH 7HE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY ET(AMINED AND
<br />IN; AND BASED ON MV
<br />^ /f TELEPHONE DATE
<br />p
<br />ki
<br />d ,
<br />)))r
<br />h INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
<br />I BELIEV S IMMEDIATELY RESPON
<br />E THE SUBMITTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE ~
<br />/
<br />J
<br />//
<br />
<br />c
<br />ar
<br />!1
<br />J
<br />,
<br />ACCURATE AND COMPLETE
<br />
<br />I AM AWARE THAT TH
<br />,
<br />ERE ARE SIGNIFICANT r
<br />~~
<br />^
<br />/
<br />`/
<br />
<br />r
<br />
<br />(~
<br />
<br />F
<br />i
<br />t
<br />l F
<br />•
<br />T
<br />l .
<br />ENALTIES FOR SUBMITTIN
<br />G FALSE INFORMATIO
<br />N
<br />INCLUDING THE /
<br />~/
<br />~/
<br />I
<br />7 r
<br />l ,
<br />`~
<br />nv
<br />3r
<br />renman
<br />D
<br />a
<br />r„~
<br />3C P , 9
<br />0 -87D-2712 V J
<br /> POSSIBILnY OF FINE AND IMPR ISONMENT. SEE 18 U.S.C. 9 1001 AND 33 U.S.C.
<br />,
<br />b f70
<br />ooe
<br />e
<br />~ r
<br />A
<br />~ $IGNATUflE OF PRINCIPAL E%ECUiNE I
<br />TYPED OR PRINTED r
<br />av up
<br />,
<br />en
<br />m
<br />mum Im~Mme ~ 6eMeen 6
<br />mon
<br />r/u end5
<br />ymrs.) GFFICEfl OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (He7etence an attachments neTeJ
<br />~' t'TLEr, IL _'. !,Ii ° S [ir T" (° .`r'~':l (L'1^ • n') 7°:LT Tc 119-vr~ 71r_ .n qn srTn rT, .-, ,. rr r..pp~ r~•T. T.
<br />... 1H, Fr". ~r~~ r, .•-;. 'l ~r r:rnrrr,{iq• nTL r rpc~5o_;:-P rnnq t.nen v~~ ~~ nn.. pt,v rSO;fLT"r• n•
<br />. •,vmr~,- rnc-.ter-^.~ .r_~n~_ nr, ' - -
<br />EPA Form 332Q1 (08-95) Previous editions mey not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) n „ ~ ~ r ~ rT ~ ~i n 1 ?-1 c'"I PAGE OF
<br />
|