|
PERMITTEE NAMEIADDRESS pM.4 FxulryNa/Locna dDldi..np
<br />NAME ~Yi-:L?.. v -- _ ...,L -
<br />ADDRESS ;71 f' d j ( F i t 5 .7 ~_ ~" , ^ p n a ~, ,-• F_
<br />• 910D `1.5' "T °-';L ~L['CL
<br />E':;LE~I~J ~~ ,InLS'.
<br />FACILITY
<br />LOCATION
<br />...t.: YOH:i T'- ~f 'i.'v ;F,N :fn f. n, 'tv
<br />NATIONDISCHARGEDMON TORING REPORT lOMRIPDESI
<br />17-761 117-191
<br />C1D0271i4 ^nq L
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ l TO `~'~' rl T1
<br />116111 l11-131 !14151 !16171 /IB-191 !30311
<br />4i 1'
<br />_ cr.IdL
<br />,., Tnv
<br />Form Approved.
<br />T nON,~6Nor, 2040-000,4.:•
<br />APProvel`e~Cp~ifei~ 05-31 ~-98
<br />•~ NOTE: Read Inetructlone belorf completing this form.
<br />PARAMETER 13 Card Onryl QUANTITY OR LOADING !4 Grd Ontyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !06531 15451 l3B-15/ !06531 154511
<br />EX OF
<br />131-371 MALY95 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rez-es/ 164681 169-701
<br />P4 SAMPLE
<br />SUREMENT
<br />E .... ~`?`-_'`• t;:?;` ..^,:
<br />2 is ~. ~; ,•-•:• ~ r
<br />~ ( ~ T~
<br />p
<br />~ Q
<br />A
<br />y le
<br /> M
<br />A D r 3Q -
<br />U
<br />is ~7iUU 1 D ? PERMIT .^-S-~Cx# ~a{sC O:k q G#` 6.5 #:"L#+e;; oar. F.. `:SLY :kaU
<br />I:FFLUE`+.' .; '~'a~` VkLtI~ REQUIREMENT #~.`-+s •F ?g;r±nr *R77rlf~ SU
<br />:/OLI DSr -iF:'i1. ~:'R `4L P, SAMPLE ~xr-aa;: r-RYRfi:X #'-,t-'•`":i'~
<br />~I /,
<br />~I
<br />!.
<br />( ? S ~
<br />~
<br />~/
<br /> MEASUREMENT A O //~ J,
<br />UU54S P ') ) PERMIT "atGCx7 -F >:.'#R4tN Pi •.: ':t :####4 Ae AF1 q. P°,PA RT 'NrE~ iRAGI
<br />i°F: ':OMMF.NTS ,^"L^F REQUIREMENT
<br />- 3()F1a dY^. DRT~LY ?T F. '!L L n7'?T
<br />~']L?D5F .iETTLF4 I1.° SAMPLE °.%A::~: '= 4;:+.=?~`.# b':^.--'~`°#
<br />I
<br />'<O
<br />'~O ( ?~~
<br />~ I
<br />/
<br />2N8
<br /> MEASUREMENT . r~ .3D
<br />?li .115 L U ~~ PERMIT .':zt6~4 ~: r:#'=;`-'fi #fck ;: 4':p';?: +- -,F+I r1?"' n,''i f 'fCFt/ :Pl n
<br />j?'IIE'•'i GP.OiS V~LUg
<br />~ REQUIREMENT #>`IR4 Q^.^? 6y.' r1T1Y MY v,~r, r71;Ti
<br />.:NC 3RER';?
<br />.'iG SAMPLE ~ {: ;t ::.: ,c t. ^. Cc ~-c .. ~....; ;;:.:; .,..;~.:..:
<br />N / ( l.a,
<br />•~
<br />N/A
<br />N
<br />' - : 7 H F Y, C F•. - ; p A V K 6'j •~ MEASUREMENT ~ A ~j+
<br />~ S S 1 'J U ~, PERMIT .~ °' ~;` RRgt01:. .' .- .-..:.:}.^ . iF . "=;s',t',• ~ ^. I ~ -. T •' : ~ /. ~
<br />:. f1 ENT F'J 55 t~i~'1c REQUIREMENT ;a+ Y4^.T -3y ., r;,i ro~~
<br />' ^ •' F N C U M DO 'T !? "
<br />n
<br />1
<br />' '
<br />1'
<br />'
<br />` SAMPLE
<br />MEASUREMENT ?
<br />~I~~~J ( ? 3 1 ^'+`L~#?:.° . ;:±+'';
<br />1n14f79tS
<br />fd
<br />'.I
<br />i~:AThEh
<br />F.M1
<br />?
<br />f.
<br />T
<br />7UUSU 1 D 0 PERMIT F:3P31t! )PiIO'.iAL %#"t-'- 'k'~". r°`vS~%v `G F'>•;,t.Y t5mt,
<br />'•:FFLOEiI," .:~~5' 1'M1',fJ~ REQUIREMENT iODA ~111G DAILY "1K nr,~, ~ ,a;:~
<br />I L -EI ' :. c - SAMPLE '.:r Rv(ci- ~ ~:~, ~... {. ,_~ ,; .; ..i: Y, it:. ,
<br />VISUAL MEASUREMENT ~ ~ O /~ VISVA
<br />ivo66 .- r PERMIT ?Cr: x'ti :k ) Y E.,>=1 ~{: t,. '11`v: ...... ~,.~^L ~.: : :t,:,r I r„o-1 v 'TCrJn.
<br />~FFLU E- ~i :. '•:); ~ .:. •1' REQUIREMENT 1'I i'T MRS '{0=D t;~': ~`
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENN.TY OF LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br />
<br />Rlcha rd Mills MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />
<br />knvlronlTlCntT?I f4ana
<br />er TRUE, ACCUMTE MD COMRETE. I /d1 AWME THAT THERE ME
<br />SIGNIFICMT PENN
<br />TIES FOR SUBMITTING FKSE INFORMATION
<br />INCLUDING
<br />970-870-2712
<br />S
<br />1~
<br />98
<br />g ,
<br />.
<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. E 1001 MD 73 SIGNATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. 1 1318. IMWtl.. uWr tMw .bNhs mFY hc/ed~ fvi,. ,a ro f 10,000 AREA
<br />TYPED OR PRINTED n,lrn,wMUn i,rprlwmw,rW Mn.wnamo~n. rd 6Ywril OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lReleronce e/1 etteeAmenfs hare) -
<br />=,•rc,eAaLe r,~F-.; ir~r:' r' 64IV~'U FL7~ F~FI 7!i l,v Io )]~)_Y:, Tl-c~ a^.n..; c.. c:.r T.. rT .rM.,"~~ r~1~~F
<br />~., LHr FOH X17 D'. ^'' -'7]' ~F ;[II"."i'4?';. ljL ~ (: P, rf,$:~o~ nl?n•^v~TTr c~r ~~ ro...,T ... wp..T .
<br />c ': o ~ o •r r N ~ r t.: ~ . n -. - _ ' . n , • N n T ~• ~ r
<br />EPA Form 3320.1 108.961 Pravloue sdmona may be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.1 r .., .. ,. n., n ~-, ~ ~ PAGE OP
<br />/:
<br />..1i
<br />
|