|
PERMITTEE NAMEJADDRESS (rrclde Facillry Nmne/Loea,ton ijDigeren,)
<br />NAME (..( r. r ~ , ... ... _ ...~ ~ -
<br />ADDRESSr• r .. _~, 1 r ~ r 1 i .. '_' r°' l•
<br />.L;,l,ll' ~D ?!ITS
<br />FACILITI'
<br />LOCATION
<br />.,TT' '0 .~ :3 -'. ~rr'i, '9 -n, `3L AT7T
<br />~/
<br /> (3 GY,d Ortyl QUANTITY OR LOADING (a Caro ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE,
<br />PARAMETER (4E53) (5461 -45) 48-53) 54-B7) EX OF TYPE
<br />(327) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 15
<br />X
<br /> (5za31 64-68 6&70
<br />C U'! ~.IC"L''! P° SAMPLE C:Y r:^^: ;y a;, ;': '*;c ,. ,..•. r. { 1l1
<br /> MEASUREMENT
<br />00044 T. C 1.4 PERMIT ~
<br />.. ,ff #ORRa '" QrtO{¢,a4rY <. ~E'r~Qpb ~~1'~I7 rr A.;,
<br />~1 K'rn/ '~,
<br />~
<br />` e't
<br />F'YFLII L+t„' ^'l5`; vl T. ii' REQUIREMENT~ .
<br />i` ,"?~ .t
<br />'= _.'-. ~RRrt y . ~ ~,,. ~{s*i t~ ''.+'tk
<br /> 3
<br />1_H SAMPLE RPtrO ~TO aa'xcas h±-fk $(e~ { ~)
<br /> MEASUREMENT
<br />
<br />CI ~) 7 7 V 1 ^. l too =P MI ." ; ~ a- , ~
<br />
<br />'-: ( . F, . fX AI~YW:':
<br />
<br />M1
<br />• rs'.e;: '.,~-" .:
<br />.' '~ ..
<br />
<br />V
<br />M1
<br />
<br />{~
<br />:. ~"
<br />•: P F L U i~ 4 T G P 0 S 5 4§ 1 rl v AEQUTREMENY ' _
<br />~ ' wM1
<br />~ r
<br />~yr T (~
<br />+~'+Yi_~1 ~'J r
<br />~ v ti3.
<br />Kip 3
<br />S
<br />~ ;vii
<br />tom!)
<br />.Q tns, .orAl. SAMPLE .'texr0 *R:rtr:x ...,.,..._.. T i,l~
<br />~C:i f'`'AOF.D MEASUREMENT
<br />G',S~C 0 D 0 PERMIT..? 7C'<fytq;r aErCTR9r41Ft; ?e4 air#n+4 lRPPO~* »rD"13$
<br />~~~'~^
<br />~
<br />-.- CO H'1 F.NT'S-RRLO-
<br />; REOU4REME ~`-.* trre.-p - r
<br />'34414 iY. RA!L7 DF1G "~/ "` I1
<br />_
<br />CI '.I JS/ ""OTAI. SAMPLE Qr"^:`^-'t SZ?GCS' ,..Y •.•.•~ / 1'7)
<br />"'1 ~:~ F V ~ 51f MEASUREMENT ~)
<br />IIU°, t U 1 D 7
<br />PERMIT ?O14~?- .,'
<br />,„.. r.-tr: ¢i~t ~ , ~ , fS -
<br />'-. w
<br />fi{~~'
<br />:-
<br />• "' ""1T :,0~5: 7114.^'• REQUIREMENT ~ _
<br />~ '" ~ rrr•• - ~+~-
<br />.. ! Mr t
<br />~O:.ID`/ iETi'LP1`+L~ SAMPLE .L`FP3G 4p z(, r.^ 1t7p~"'y ( l .)
<br /> MEASUREMENT
<br />.^,D545 n 7 n ~ ~
<br />:g. :PERMIT`; ?" a aka aa~s6e ?l x+-r• # ~#'~ RB~LtRT" .~i ~. ';"k3
<br />,. ~
<br />~ ~;
<br />~
<br />
<br />~ c `. CO ~ r p~ Y T ^ a a L 7 Y
<br />• RE~UIRIEIvT~N -
<br />,
<br />};;,i
<br />trre:;.
<br />` ~•" - -
<br />`
<br />:.Ui.: )S/ rY.TTL'r ~,'I.
<br />SAMPLE 4?'`-: r.? a., r,~r.S .,. ..... ,r
<br />{ )
<br /> MEASUREMENT
<br />'I!1S1S 1 U 7 PERMIT- '~lMR~11D3 ,.' Atfir74P>i ... pan a tr4+Q4sX'dr ;'!kT` ' ~rjk~9Y" _~~C) (y'Cr'~"~.'- gs
<br />' T'?LUE~NT i,P^3; VAI, LIF REQUIREMENT ';;_ s, t,-^rv -
<br />~t!!1A ` A i!:,
<br />41l T L * «Tf
<br />° T. / L
<br />Mf)1f ",
<br />rl
<br />:Iv t: via e: :l" SAMPLE ,.•:t?h" r, r. T: 'r :. :e F,.ti...._.- t... ,t..,~~ ( Tn1
<br /> MEASUREMENT
<br />CO-,55 ] U ^
<br />PERMIT RpitCIM# paa OR#' 4 +•?~ #-+taaaa h-'k#4t+#+k ^ r
<br />~lfl'~'M"
<br />{{
<br />?''' L SI £ Y: V R J C c n D{ ~' •~ REQUIREMENT r + r +ti'•
<br />NAMEITITLE PAINCIPAL EXECUTVE OFFICEFI I CERTIFY UNDER PENALTY OF
<br />AM FAMILIPA WRH THE INFORM LAW THAT I HAVE PERSONALLY E](AMINED AND
<br />ATION SUBMITTED HEREIN
<br />ANO BASED ON MY TELEPHONE DATE
<br />RICha rd ~ it I L INQUIRY OF THOSE INDMOUAL ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING ' /
<br /> THE INFORMA770N, I BELIEV
<br />TE A E 7HE SUBMITTED INFORMATION IS TRUE,
<br />~~
<br />environmental ;.'.nnar.~r ACCURA
<br />ND COMPLETE.
<br />PENALTIES FOR SUBMfmN 1 AM AWgRE THAT THERE ARE SIGNIFICANT
<br />G FALSE INFORMATI
<br />INCLUDIN
<br />N
<br />THE r/ a7p_g70-'_712
<br />l
<br />
<br />IBILfiY O
<br />FINE AND I ,
<br />O
<br />G
<br />NMEN _ O
<br /> POSS
<br />F
<br />MPRI
<br />P
<br />h
<br />/ SO
<br />T. SEE 1B U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED § 1318. (
<br />enett
<br />es antler t
<br />eca smtums may Inclutle flnW up b (10,000 antl or
<br />metlmum /mylswmem of haMeen 6 rrion0rc entl5 ye/,/.) OFFICER OR AUTHORIZED AGFNT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLA uUrv5 (Hererence FLIT eDacnmenrs nere)
<br />.iL":~H!7 A: is L'r`.. ,:'n. ,~;/ T ~N, ec+pL..A ~L^ ,-~T,pD°. (L7' /r/4 .nT .( ~,T . = 1^_a'r~ -. (y_u., nn :- .r, -q ..:T.
<br />~L47.M!?n. °c. T. •.%~ r; 1C/ c~a nfl~l,^'' ~P ni27~`' a?.IiI7cT,.,..',....~ -IT!. ~ ^rs.1r..-.-r.n cnf-e„tr~„^ r/~ r+/; i.
<br />.np•.cv -. nr.., .. .. ~. ., .. ~, .,r,., -,.gym .~.. .. _.. .. .T ~.. .. ~..
<br />EPA Form 3320.1 (08.95) Previous editions may not be used. (REPLACES EPA FORM T~ WHICN MAY NO7 BE USED.) ~ ,T t l S / ~ T n rl t '- ] ~ n N PAGE t OF
<br />NATIONAL PoLLUTAM DISCHARGE ELIMINATION SYSTEM MPDES) FOfm AppfOVed.
<br />DISCHARGE MONITORING REPORT (DMR~ OMB NO. 2040-0004
<br />(146) (1)- 8) .• T • ~•
<br />~ n 9 '` ~ s q n n ~ , r r , .. •, _ ^.) Approval expires 05-31-98
<br />PERMIT NUMBER DISCHARGE NUMBER _ _ qT rT ..,).Imp
<br />MONITORING PERIOD V' ~ ^ t / ~ r;"•' m „n %'^T ~ ~•' "• rr ••
<br />YEAR MO DAY YEAR MO DAY
<br />FROM a ..~ TO i•.. ~n _ -i -, ,. r..te^rr I 4 ~.~. .
<br />Tl0-z,) Rz-z3) a+zs) rzuzr) (ze~ze) (30371 L ~ NOTE: Read InsVUCfions befo co plating this form. I
<br />1
<br />
|