Laserfiche WebLink
PERMn'iEE NAME/ADORESSQwriiFaNryNrWLe.rrw /Dlse.rwq <br />NAME SCq:.CA C'JAL :;U': A'.Y <br />ADDRESS C n A W c R U <br />HAYL'tN ;) ,iE)q <br />FACKRY <br />Lt1CATION'i ; Y i! E N ,. ~+ <br />i ': 3 J <br />AiI'+i: ';LID ,121:7_ -..I ~. <br />MATIOMIV. pOLIUTNIT dSCNMBF FIIMINATION SYBTW /INPDESI <br />DISCHARGE MONRORINO REPORT (OMRI <br />r n~l'.n r rl n I J <br />PERMIT NUMBER ~ ascRnrwE RUrdsEn <br />~a <br />MONITORING PERIOD <br />YEAR MO DAY1~ YEAR MO OAY <br />FROM Q~' ~ ', Q1Z ~TO 0 J i 1 3 I <br />,viar <br />`1 <br />. - FINAL <br />:'I~CtiANGE TU SA:;E' C.`Ic.LY. <br />• s. <br />eGarT <br />x:za NO DISCHARGE )__) ~^'~ <br />NOTE:,'RAAd bwtructlar b~fa~ eompbtlnp thb lam. <br />PARAMETER QUANTITY OR LOADI <br />~ Y <br />~ <br />Quality or Concentration NO, <br /> <br />EX rREauENCr <br />o. SAMPLE <br /> <br />TYPE <br /> ~ ~ ANarye <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS <br /> <br />I- SAMPLE <br />MEASUREMENT <br />~ `:.t .. . <br />,... . .- <br />Z <br />~y <br />:X ; :c::~:y <br />~ <br />~ ~ <br />~.( 12) <br />/~ <br />I2 <br /> 'U ~ ` l/ C <br />UiIUJJ J J ~: PERMIT ;•-i~rf.:.:;-~.:: ~:~.n'.? <br /> <br /> <br />. <br />., <br />~ ~:.f, ..'.'... <br />~+ ~ ~`;.,'.':..:';..':'.'..~::~ : :9l~;tti/~: Cti~'T~; <br />:. f'f Ll:Etii C.'%:i ~ 'd .. i..l~ REQUIREMENT <br />.. :.: .. .. '. ~ ..':. <br />~~ 4F i1~ .: ~1n':?t,_hai iy. ~ <br />~ .:.., .:. <br />~ <br />~ ~ '.il lM r:;N`^%~ : <br />S,iLI~S, :~TAy SAMPLE <br />MEASUREMENT . . .. p:;::. ,~.' 04tk#~%~ <br />~ <br />~ ( 19) ( <br />~% <br />C <br />:; J F 1 D!: fl ; 'J'/u <br /> <br />b'i51U i U U '~~~ 'PERMIT <br />~~. ~ ~ ~~ <br />-:..:•:, ~~ •.?- <br /> <br />,..;... <br />, <br /> <br /> <br /> <br />.... <br />... <br />~Le~~4 i+~~0 .~ <br />~~ :'. <br /> <br /> <br /> <br />: <br />;~7~ ':: .. ~ <br /> <br /> <br />~ <br />~~ <br />i:9 C:. ts/ <br />ir;Au <br />t~FFL';E':f rili~;_ V?L'J, REQUIREMENT <br />...~ :. ~ <br />.,: ~~~. ~~ ~ ~~ ~ <br />.: ::. .: :, :. ~.. <br />. a:.::ci <br />~f.C.~.'ta. ::.4:.1 <br />.:.:y::.r:a aC/I. ~rla~!'I•h <br />•;;LIi,.i, '~ra'fL~.,1r,L saMPLE <br />MEASUREMENT ~.•:: „-~:. ,>r.~et~,e <br />t l <br />f ( lei) r <br />~ <br /> I <br />{ Du .~ ~ w 3() ru <br />'.I '~ ~ u S 1 . ~.. ~ PERMIT <br />~~ <br />~ <br />~ <br />.... <br />.': <br />.... <br /> <br />,.;b - <br />\ <br />, <br /> <br />;i <br />I <br />cF}'Li1r '. I' GRJ~S V6L li ~REOUIREMENT <br />...:::: .....: .. .. ,':.: <br />~~~ ~ . <br />. ...... .. ~:.~ ~ ~ .. <br />~~~ •.r : .. r ~: <br />•.'k ~ :. <br />~"S~It.. <br />Y, t./L <br />, .~.:+•q <br />~ <br />~ <br />I !',i4, I'.>rAL <br />(.S _, FE) SAMPLE <br />MEASUREMENT .; 1, r: ~; ~: .i.. ,;:.: ~:;:-CI <br />~ ^ <br />! / 1.~. <br />~~ ~ <br />( 19) <br />n <br />I3d <br />rva <br />' 1 ; .1'i :; 1 U U ':::..RERMIT ... .- :.::: _; ~_ ~:.r..:5; ... + .` ~ ~ f:~::;(~ ' ~•, ~:: ~ ~ A ~. <br />J <br /> <br />~r'L~:F'.f .^.MnSS VALII ~ REQUIREMENT <br />.'.:. .., .. - ' <br />.. .' <br />". .::. <br />'::': :: <br />.[ .~: ~. <br />~. `~l':''::4 ~'1?~:a ~~~.~ <br />: <br />~ <br />F*G/L <br />.. . <br />C"; ::"J: <br />. <br />,. <br />'~ ::. p y I ~ .. _ <br />.;~r ~ SAMPLE ..... <br />. ;, ..,.. <br />~ ...... <br />~ ~~ ~ :..~: <br />,. r . I <br />~~"~ <br />'`'`COs''' <br />( 19) <br /> MEASUREMENT n - <br /> ..::: PERMI ~ ~ .. ~ ~ .:.....:....._ .. <br />' <br />' <br /> <br />'r r'1. II: NT GF: '7':ti Vhi.;l REDUIREMENT <br />....... , <br />...~.. <br /> <br /> <br /> <br />..... <br /> <br />.:. .... <br />- <br /> <br />..._.. <br /> <br />. <br />~ <br /> <br /> <br />. '.:: <br />. <br />... <br /> <br /> <br /> <br />.. <br />:. ~ . <br />,... <br /> <br /> <br /> <br /> <br />. <br />~ <br /> <br /> <br /> <br /> <br />...: <br />r'L~w, :'. CJ"QUIT Or <br />I' i; %? J ': '~ :. ~~ 7 7! E r, T PLAN' SAMPLE <br />MEASUREMENT ..11 <br />pV. ~~D! <br />~ <br />~~. ~~ t ~ ll) :: ,;: ;: -: -z:: ._ ... r ,y;::.:;:-: ~ I~/ <br />4rl <br />U c <br />'~JU7J 1 U U ~?..PERMIT.: .~~~c~.:.~:;~:?~l' :rFi.~.:::;.~ <br />, ~ -. <br />,e <br />... <br />t :~ <br />:.:I~ IASTAI <br />.r'h'r U,: ,: :: F:ISS V;. L11 .REQUIREMENT <br />~. i:'.%;1. t,.t. ..~{.. ..t:l ,/;: <br />,.. . <br /> <br />.. <br />!; i. .i'i :J :.Y [."J ~ SAMPLE <br />MEASUREMENT .~:I. "v ;v :j {: ~: . .::;';~G~i q'C ~ U <br />~ 1 ~ <br />/ ~ <br />~/ I <br />/ Q ~Yv4 <br />7,,1•i5 1 J U ....PERMIT .,:.A .. <br />'S` . , .. <br /> <br />::. <br />`' <br /> <br /> <br /> <br />. <br />:;=`. •,-.+~ <br /> <br /> <br /> <br /> <br />.- .. .J'i <br />:.' <br /> <br /> <br /> <br />.: <br />• <br />Vii. <br />c <br />~.. T;LY GkAi? <br />' REQUIREMENT <br />" ...~ . ~ .: '.. ~ <br />.~~. . , <br />r <br />`ir <br />Lil{'Ji ;: F:7S `: VA7.11 . .. ~:. ~ .. .. .. ...: <br /> <br />~•~ „ <br />.yj <br />:~J.: <br />?.G/L <br />NAME/TFiLE PRINCIPAL EXECUTNE OFFlCER "`^"r° "pn.vn .. IM1n u <br />prtpnetl undrt mr tlinetlnn ur ap l. ae<u.nrm.ntl .u .n.rnnenu w.n <br />nblsn In netudrnrt wI1M1 . <br />^ru deY <br />nN <br /> <br />^ TELEPHONE DATE <br /> q <br />[ <br />Iq urvrt IM1nI quNllled prpnM prgprrry [n1M1rr nM eerNrlr IM1r Inremulbn ~ <br />/ <br />/) <br />( <br />` <br /> NbMlled. Sued en ur Inqulr, of do pnsn w p.yru wbn mnn.[e IIw p.nn4 `, <br />// <br />` <br />1 <br />l <br /> w IM1Ue poem tll,ardr mpMbk fw plM1eNn[ Ibe Inrgrm.Uaq, Ne Inromullon ~ <br />/~]Lt-.~ 31I r~_ 1 <br /> <br />W bMlled 4 b IM1e bl o~ m) YnnwYdp nN Mger, lrvr. M[vnle, n,N mmpNle. <br />Iqu nwnrt uu lM1rrt nrtl <br />Nnanl <br />,uldu ter <br />hl <br />bM <br />tl <br />l <br /> <br />~INCR <br />r <br />IGNA711RE <br />EXECI7T <br />F <br />D + <br />O I <br />1 C <br />l <br />~ p <br />a <br />l <br />w <br />nranulbn, <br />i <br />n[ <br />I f <br />O <br />~ <br />AL <br />IVE A <br />TYP® OR PRINTED mwln[d.p®IM1loy.rn~.na r~nval+onmenl rn.M1rowlry .iWnllgrs DFFlaR oR AUTHOgIZED ADENT ~ NUMBER YEAR MO DAV <br />..vmmv+~~nnv cam. v.nn.,.... ... r-... ........,vn~rnvomc~wi wu~cnmmea nl/q a. <br />TS5 s i':Ot: LIt::T.i :: LL ~7;i ;AIY:iU t; '-.~.fL:.A3LF. SULIPS LIMIT APPLIED FJK <=10Y',.'.4F~, ~~~!:~IC ::Vdt:T~ .SS :. <br />ItlJtl LInIT5 ~AIV C~ F:ir ~lUY4, 14Nn ??:.SIP i,V R:i I' SU_r,7 FCT i~) BU i?D Ld OF PhOOF L4 I. A.:i. GIL ~ Git P.AS~ - S:;i <br />EPA•Fdrm13320.1 (Rev`3/99) Previiilis'edilions may be'used.` n This is a 4-pan form.. PAGE OF <br />00052lOuv'plT-,~o1~ 1 <br />