|
PERMITTEE NAME/ADDRESS pwJNrF«YIryM«r/Lor•IIw gDIp,..•p
<br />NAME ~. V .T .. .... .. .. ..- .. _
<br />ADDRESS ~ ~iI (~:, ..• l r .a ~. } ~ ii .~ _ ~. ° 7. 'i (' =
<br />~t I. 74.1 r F -n - .• ~ ~ .-. .`.'L.
<br />FACILITY
<br />LOCATION
<br />NATIONDISCHARGEDMON TORING REPORT IOMRIPDES)
<br />I1-161 1I7-191
<br />^7211i'1 ^1~ s
<br />PERMIT NUMBER DISCMMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 49 '? J TO 'a"' nL TI}
<br />120.711 l17-731 111-151 !I6-I71 178-191 !363/1
<br />Form Approved.
<br />• ,; •_ - ~ -. A ,..TOMB-No: 2040-0004- ,
<br />(`=.1'r, .,~ Approve! expi~ee.05-31-98
<br />_ r•
<br />+r 1n^
<br />-1 f.1
<br />NOTE: Read Instruetione belwe compiating this form. •
<br />PARAMETER 13 Grd Ontyl QUANTITY OR LOADING !I Grd OnlYl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE
<br /> !46531 /5a-511 !38-15 116-531 154-5/1
<br />EX OF
<br />TYPE
<br />l37-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ls7.s]1 MAtr515
<br />184-881 159-701
<br /> SAMPLE
<br />MEASUREMENT "~C': '-C~
<br />r ,J
<br />~' I'I Jry-~
<br />V
<br />~ _
<br />{ ' ^)
<br />O
<br />53
<br />~ ~"g
<br /> r 0
<br />'I il'1 ~'La ;7 ~ PERMIT Sv'=GRa' r.: ,^F ts;:',c-f' r! ts:kk 6.. -:I+.: ;: C~:k'. ran ~'QYLyr far,
<br />.': L~4.~~ .i'1 ;1=r ye. Li~I. REQUIREMENT etrtp4 JTI,{jes;?ra nr,P rpl!'rF cn
<br />_ -.IU~~ ~~T'1'L''A"LP
<br />• SAMPLE .-: R: CY k•^-C ~`:# ..
<br />~ --II n
<br />rv/ '""
<br />( T'
<br />~
<br />~/
<br /> MEASUREMENT A !, O /Q ~
<br />''",'l i ' ' U .PERMIT ~f#C ?'33 :zarv.!L -'.• : r^k ~'.=#,G4~ qF ^D`?"` RsnO S?? t lti':`E/ 7~1~''
<br />j:':: ^.J. .r5 :I ^i Op REQUIREMENT r,S`.r '~On+1 iV^, ++ITLT MX Mi./L "!'T4T?i
<br />]JLIll~r `~'-'i?'LF+:fL`; SAMPLE ~. .. 4=k::.rr;: ,-~:r,::~^: r:
<br />~O
<br />~
<br />~ O
<br />i ~ 'r`)
<br />O
<br />11 ~21
<br />r
<br /> MEASUREMENT r ! 30 ~U
<br />'`JiJS i .. ~ PERMIT. k{'t:p~XC "a d;. `:g"~ .~ „~:r;,t<'t-; ~,On,,m ~~S- M^~/ ~~E.
<br />-p°:~JF~ ,FUSS ~'f.i't REQUIREMENT ~:,k': Inn.*, iY^, Rq'IS' °Y 'a?/L. ~,Y.iTIi
<br />I Ari!' .aFS''9
<br />- SAMPLE ...... is~:;:.~..::~ ... ~~:r:
<br />NS ( ~ al
<br />~/
<br />N/
<br />I ~' :i c 5; P 4- o F ~ "!
<br />' MEASUREMENT A O ~ q
<br />nC h 1 (3 PERMIT .-. ~ :Ti'~:=:ffi .. r'.: y:X .~: ]. I' S .);-j~ .
<br />r'•Lllc"!' oFU ;, n~. REQUIREMENT ~ r:r-{: _k mot..-,.. ,. R. 't
<br />~ ;//. ~~T
<br />,
<br />•' '. J TH _lN^!1' "1 ~
<br />~ SAMPLE 2'2,
<br />' ~ Z ( ~3) .y~r: ~:'.-;:
<br />~ •
<br />. _ti~:-';rr~ uu
<br />- ~`
<br />'i: ~L 4 f:A'f "r F'+ : ;. 5 r
<br />L :~ MEASUREMENT ~112OI OF
<br />r/ O 1 11.1StAN
<br />j^I; ..O ? Cl .. PERMIT I?`~Y J3.P ?E''^I7gAL ,..=`-''-.1#:- ... "k rt..-. .. :. rt } .. ,T I a,"^'1
<br />. i.U7: ',F ~R75' U17'rc REQUIREMENT 3hUF. ~. Ilv D9TL° i!Y `": _"'
<br />d. ';C `.Hh'E ~I SAMPLE .:_t:. Cr .. { I~) ...ra:..:.: is ".•a f:-,.y . e7 ;yfi.~. /-
<br />(- : a, :T I, MEASUREMENT v O 7 3c~ 1~(,SVA
<br />'-}':C'. ! :7 ;) PERMIT a:':r~``.;: j T °^=1 'k t:i,: ,.., ~, xC.k~:.;w ~~.t ;•:F^'.; -'CY 'T;'.'Lr
<br />_ ; n.}' .r ~ ;, !; ~ REQUIREMENT j * w f ~ ;~ ~: ;~ ~:
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT '
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY OF
<br />AM FAMILIM MATH THE INFO LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />RMATION SUBMnTEO HEREIN; MD BASED ON TELEPHONE DATE
<br />
<br />
<br />F:IChe'rd I`' 1115
<br />MY INQUIRY OF THOSE INDINDUALS IMMEDIATEIr RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS //~~~ ,~
<br />.
<br />,
<br />J~
<br />/
<br />n
<br />
<br />nental 1~12n
<br />a
<br />er
<br />!?
<br />l TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING /
<br />~
<br />'(
<br />j(
<br />/
<br />97L`'ISIJ-Z712
<br />S
<br />~~
<br />90
<br />,
<br />g
<br />nv
<br />°onr ,
<br />THE POSSIBILITY OF RNE AND IMPNSONMENT. SEE 15 U.S.C. 1 1001 MD ]] gIONATURE OF PRINCIPAL EXECUTIVE
<br /> U.S.C. E 1]10. !r\+•IW Mdr Ur« mruh• m•Y JTCJrJ• rvr• uP ro 710.000 AREA
<br />TYPED OR PRINTED .n4nmM:.rue JrpiwtrlnwrrWbrw«nsmoner•rM SY•vA/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIULAI IVN1S lHe/wenCe en eftecnmsnts nsrel
<br />'TL.'r.'IL`'" •^1.' L`..r_ I •1l'. {{ F~F1 ,a.1•r - li',_r ~ n.,_ .. ~. ,_ r~..T z- r .- .~~
<br />;~
<br />or- I,J :'J-, ~':1 '. ,c .J"+= 'i•. ~'1 I-: 5°'"~• '*. -'o'. .. -. r^1:1 ~.~. ../, r ~.. -r ~r ..,r-,~r
<br />~A Form 3320.1 108-951 Previous aditian5 mey ~be used. /REPLACES EPA FORM T<0 WHICH MAY NOT BE USED.1 „ i i ~ r ,~ ~ ~ _ i „ I . PAGE ~ OF
<br />i
<br />
|