|
IERMITT[E NAME/ADO R[]] (/nCIYd[
<br />FaNiry Name/LDnrbn iJdrfJerenr)
<br />Y
<br />iNILMs_1r-~--_-------------
<br />AOORE~IitMDJ tyt_.=JJ-_i_-___Y___
<br />G }IG LL WGOI'i CL C. ~JJ
<br />PweluTV _
<br />LOCATION
<br />M ATIOM AL fOLLU TAMT OI]CNARGE ELIM IMATION ]YSTCM /NiDESI
<br />DISCHARGE MONITORING REPORT /DMRI
<br />z-7e ~ / )9 ~ ° ~ ~ ` Form Approved.
<br />C L v ~ 17 i ~ 4 ~ t,1 ?I (5 l' 6 ri n .) OMB(NtS.12040-0004.
<br />PERMIT NUMBER RncNwRCE NoM]u ~~ - L I ~. JI t Approval expires 6-30-91.
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY ~~
<br />FROM JU 'JJ Vi TO -y .r _rl •v' IYC Lt .`1.i 1::'~t ~__~ •"
<br />nn.TII nz.zrr n1.TV nA-nl rlR~~91 Irn.rn NOTE: Rand instruetiom before completing this form.
<br /> (3 Curd Only) OU ANTITY OR LOADING (4 Card Only) OU ALITY OR CONCENTRATION
<br />FREQUENCY
<br />SAM PLE
<br />PARAMETER (16-33) (3161) (fib-1J) (16J3) (N6/) NO'
<br />E% of TYPE
<br />(3t //) ANALYSIS
<br /> AVERAGE MA%IMUM UNITB MINIMUM AVERAGE ~A%IM')A UNITS 676A 61
<br />6
<br />81 (
<br />( lAV-/D)
<br /> 1 _
<br />_1,+::UCTiYit 6AMPLE .:.:~:f;::. :,::}:,::~_:=: ( ) ~Tfi'S~:~~? ( J.i) O .~
<br />6p
<br />'T~
<br />~ ~Ir,A~
<br />
<br />MEABUREMENT
<br />`J
<br />S(~ I'K+
<br />SG
<br />U S14 1 :. ~ "° • ~ ' ~~' ;,
<br />T°
<br />I ' o-+~'~7~'
<br />u' T,e~ a ; ~
<br />'~ai.~ %~4°
<br />. oa:j~ m x ~r"~°'+E?~`~
<br />°zi y,.;e :,
<br />(f';$a`Ta ...: '"x k`.~'f+°
<br />°;~
<br />;
<br />«; t3~~ M r.
<br />1. t / ~~,
<br />:
<br />.'(I
<br />~
<br />~~ af`
<br />'R" ~;.. '.
<br />
<br />p R /)
<br />'
<br />PER
<br />A )
<br />RBQIIINGM EA7a r
<br />5~
<br />° ,
<br />,,
<br />'ixs °+x
<br />R'~L4 x
<br />
<br /><
<br />~y
<br />~~'a
<br />~ ~
<br />~a
<br />a
<br />~
<br />~~
<br />a ~
<br />CA
<br />`
<br />'
<br />~
<br />y
<br />q(
<br />" `k ~
<br />.
<br />O JJ YrI L,
<br />rILDL.hl vlA <
<br />.. 4 .
<br />~
<br />9
<br />~ °
<br />p
<br />" R
<br />,a .a a-JA"
<br />_a y
<br />b
<br />~ <. qa$
<br />
<br />-'
<br />6AMPLE .' fi
<br />rr
<br />~:. ~~
<br />4 L'~:t ( )
<br />c
<br />~ :}~Ri7:r C: ( `Z)
<br />//'~~ .S /' i21~13
<br />`
<br />
<br />MEABUREMENT
<br />/
<br /><
<br />A
<br />~I l
<br /> .
<br />.il-il J 1 V' .. ... .. ,•A~
<br />E °~"
<br />.~~dY ar6
<br />• `s ~. a e`?gbYq°" :3:%4 k.'a~.•x+y i"s•,•,
<br />t' ~ ,~~T-e •,':.•
<br />~ n~ ,~g p'x ~~ ~'~~'~%a "1?~'b'.
<br /> tREM BNTx
<br />•REDL °
<br />~%'+ .n " (='u '" e
<br />' #;k0 +~t is
<br />~
<br />"
<br />• r
<br />xa „"f~.>
<br />'
<br />° p.,
<br />'~
<br />~
<br />~°h~
<br />1
<br />°°
<br />5J s, F ~<"
<br />~/
<br />~[ -LLl :. lv1 {.hOS= Jni
<br />- s. .a„ c:f
<br />.... . +x°"r°na, :.
<br />~ s
<br />:Ya
<br />.
<br />.. tY ~
<br />e~(tt°ll kl
<br />• a
<br />°
<br />,
<br />I ~
<br />f
<br />@
<br />z.~
<br />~ °
<br />. ,a,
<br />...
<br />~ilLl.us, TuTaL SAMPLE a~a~?~:•v -j
<br />o:t::~:/ ( ) ;[aE~ca~. / N~f ( i'i) N~ N/
<br />
<br />MEA6UREMENT A 1 p ^ A
<br />...DJY GN ~'t.J
<br />
<br />i JJ J O ~ 'J
<br />. a
<br />''x "
<br />F
<br />r
<br />.l'd~;~~'.'4 m
<br />f~!..
<br />>•t
<br />°~{f+f
<br />fy?::,:
<br />3+ w'AIr. F
<br />~°">
<br />.,,A'~
<br />~. ~{~„£' a s e ~°
<br />~`..csP U~~*
<br />~
<br />~
<br />u ;
<br />~~~ I~~,
<br />Si~~'p ° <«.
<br />" PL
<br />R
<br />f6T
<br />j±E0U9REM ENTe Via, y
<br />,
<br />`=~m 4##~+ <
<br />°
<br />i "aq g
<br /><~Ya~
<br />~
<br />1a'~
<br />:
<br />~~ .
<br />~
<br />e
<br />L•~
<br />'
<br />Tf(~
<br />r
<br />4
<br />~ I5G/t °
<br />~'tk'~I ~'~ °_:
<br />' L CtJP }i r. .
<br />i_ GkLOM n.
<br />°
<br />~ W a
<br />.
<br />a n
<br />i,
<br />k s
<br />-
<br />„ .,
<br />,
<br />,
<br />,
<br />;
<br />eY 1 . "
<br />.LIDJa .b.-AL
<br />' SAMPLE
<br />R
<br />MENT r
<br />.: ~:
<br />1~ O'.i i{i: ~%f ( ) P-F?air-' '~./
<br />!/-n (J.S ~~ ~ iJ) ~ y1ZA~
<br /> MEASU
<br />E ~
<br />. J J U : v sm~"PERM-i;F • < z . ~A>~'$s.~ ~
<br />° ';~i~,~~9F I'~'IL~ .. e r iir''x°~S v S:~"yi~'
<br />s . .1 :x Q
<br />" a '.
<br />( `
<br />Po
<br />~'s
<br />r
<br />~
<br />°A's
<br />e
<br />. }§':f ~. ~/« f3 y~ ~,.J
<br />>
<br />,
<br />' .. SREQUIREM F.iI T. 'f `.r ~<,
<br />°a
<br />~ ~ ~
<br />~° .
<br />~$s!.
<br />~
<br />~
<br />°'
<br />° ~ -q
<br />v..
<br />q
<br />y
<br /><
<br />6
<br />1
<br />>!
<br />~
<br />~
<br />~
<br />R ~~rJ/ °s, ~
<br />(T
<br />~e~1~ ,
<br />
<br />.i. L,r;GS5 YlLU1i
<br />i f FLU.:
<br />s
<br />°
<br />
<br />>
<br />.. a
<br />r+~.xr:
<br />~
<br />c
<br />
<br />r
<br />
<br />s >
<br />fi.
<br />~
<br />4 w
<br />R,
<br />sca
<br />e 4r .~ ,
<br />i
<br />i
<br />.
<br />D[JLiilS] ., ..."1'LEABL6 BAMPLE
<br />MEABUREMENT ~~-lr•.t.Fi- IO9p#=f~.} (
<br />) -.I:,;:ta-~:>: ~~~ ~~R .~) ~ NIA NIA
<br />
<br />~Ir~ v L G ,r, ,. .,. m •K#F rY°~~a;' ~
<br />~>~ =3=~;: m°t;::tf
<br />s~lyT r~. ~. ~. ; L, i r~r-°m°: .. a a
<br />
<br />' 7IEQUIREM EN:f° x
<br />•a
<br />°
<br />' ~~~~ .
<br />'°:x<: «
<br />a °~-'¢ s
<br />Rlle
<br />FJ~
<br />s~
<br />'
<br />~I
<br />L`~!3
<br />1;'~~m
<br />~:
<br />11L/L %
<br />!
<br />I~4
<br />
<br />tl
<br />]rnctiTS :1.
<br />~. ~ <.,: ,
<br />g ~. .~
<br />,
<br />:
<br />.
<br />.. :
<br />„
<br />r
<br />;~
<br />. . :
<br />>
<br />3.)LiJJP jETTLi.:J.,i SAMPLE J~v i:Fi :}y:;r}.}:,Y ( ) ,iv'. r+. l
<br />~~r l I
<br />~~i
<br />( L5)
<br />O `~.+ ///n1
<br />~
<br />l~A'~
<br /> MEABUREMENT l . l
<br />V ~ -, J 1 C _ '~ •PERM~IT, .., .~~'a ~i,YB3:Fz ° ,'~~a'~'. 4~,YF~i.¢~x'Q i~k L= ; ~%iA~'yy.. ~d
<br />'YA
<br />~ Ae x [~ g'(t~a ,'
<br />i ~r AY Eriyt' ° (' `,
<br />c~' d':~'Crz A.r a
<br />AaA
<br />~~/ 2.~~,'
<br />
<br />~
<br />
<br />: Y
<br />`
<br />L
<br />-
<br />H
<br />= ,RE SI'RE61'ENT
<br />°
<br />
<br />~
<br />"`Y'?` C m>~
<br />Ae;€1~~r^
<br />'~~';f
<br />gD~`T~;ye~~C~ +•
<br />L/L •
<br />~
<br />~;~
<br />!(tYi€Y
<br />~zi~
<br />`~
<br />a
<br />.
<br />.
<br />LUr,
<br />tT G
<br />C., :.a ;
<br />e ~ .
<br />g , . x ~
<br />~~ :,NG ~F(Eh:3i
<br />BAMPLE
<br />MEASUREMENT ..,,
<br />I:;;;:r :..•.
<br />-I. ( ) ,.. r.. ... ^~IA ( ~~) d /
<br />~/F1 N/A
<br />[,
<br />r -( ..L :~ L}. i h-i; h n J .., ~ }(
<br />
<br />Cb 1 ~~ 1~
<br />•J
<br />a. ° °Q aall
<br />°°~.'A!'~a+Lj4'
<br />•Ax~~'~~'~3}~b
<br />':x t: ~ry
<br />iw'~#r~vP "4~°
<br />a
<br />x~Ny'~b `Pr~i ~y ~
<br />~ ~e
<br />.x p a
<br />.°
<br />e
<br />°
<br />~
<br />.L f
<br />R ?'a r~ ~
<br />~'1
<br />]Y'~~`i
<br />jq~" °~~
<br />:
<br />l;
<br />~ 'RCOt11REMENT:' •-~•: r' °s
<br />pg' °a e ~
<br />' ~x
<br />[
<br />(
<br />~c
<br />3
<br />t
<br />~ aIL i
<br />"~BT ~
<br />U~ ~a
<br />:
<br />.L
<br />J.Vufi 1
<br />GrL1J:J p. x
<br />.
<br />° g
<br />s, x.eA
<br />u.
<br />NY s Aa ~
<br />NAME/TITLE PRINCIPAL E%6C UTIVE OFFICER I CCRTIfY uXD[w PENALTY OF LAw THAT I NAVE PER6pNwLLr [AwMIN[D
<br />IAR WITH THE INFORMATION SUBMITTED HERflN AND BIrSED
<br />w
<br />fwMI TELEPHONE D A T E
<br /> ND AM
<br />L
<br />ON MY INQUIRY Oi TNO$[ INDIV IDUIrLS IMM[DI/rTELY R[$PON$IBLE fOR
<br />4 I BELICVE THE SUBMITTED INFORMATION
<br />G THE INFORMAT10
<br />O ~J
<br />// , ~J `
<br />Richard 1 llllS BTAININ
<br />.
<br />E ACCURI:TE AND COMPLETE I wM wWARC THAT THERE ARE SIG
<br />IS TR J
<br />/ ~
<br />
<br />F
<br />'\
<br />71 U
<br />NIr ICLNi PENALTIES fOll SVB.IITTING iwLSE MFDRMAiION INCLUDING r',
<br />~"'~ f ~/ q
<br />/
<br />f ~ r e ~ Y I O-Z / ~ ~
<br />l~
<br />I{ •~
<br />l / p
<br />SIL
<br />.
<br />s a~,er
<br />nvironr"ent~l SC S IDDI w
<br />PR
<br />SONMENT SEE IB
<br /> I
<br />LNE POSSIBILITY Of rINC wND IM
<br />U
<br />ND
<br />r ualul+. mvr mrludr l
<br />Slb Wn
<br />rAa
<br />n+. u
<br />n
<br />GC S ITS rP
<br />i
<br />M
<br />33
<br />SIGNATURE OF PRINCIPAL E%ECUTIVE
<br />TYPED OR PRINTED :
<br />.
<br />y
<br />.
<br />.m
<br />nr. .
<br />n
<br />u
<br />o.dn.mr,rnl~m rnrP•~•nrlnl.I.r../Mlu.+nAmnnrA.ondi•+Rr.I OFFICER OR AUTNORIZED AGENT AREA NUMBER YEAR MO DAY
<br />COMMENT AND EXPLANATION OF ANY VIOLATION6 (Nelrrmcr uu urruanmenre nrrel
<br />.. ~_. dtl i+5. L.. I~.., p'. ]~Ji ~ i'.1 LL.-?.. ~L ~~L.: .,_ (:.JL. EJs) .~ ~.C ;~:.iY lr _ ..I.-[.:a ~.-L':~ :t .. ^..L tti_.._ ...
<br />L ...1I 1f.v• _:,_ ,.. ~. GF Ile yr CIVI .:1JC(r Li c~ i'.ivl.: h.,•1 :.. _u._[vJ• ~.~~ - ~(..n„..'-~•~~ I:..L I:.i ~! SI• t~
<br />EPA Form 9320.1 (Rw. 9.8!) PreNous Bditions may tl8 used. (REPLACes EPw FORM T-AO WNICN NAY MOT ^[ U][D.I -. .~ / - ~ PAGE OF
<br />v.. i.. , -U.. il.l_ --t ..i4
<br />1
<br />
|