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PERMITTEE NAMFJADDRE55 (7.iil. fsWryNe•/lanlm VDls....c NAME T6&tlJii ~r;L'-3{ ~J'Ii'A.iIY ADDRESS TERRJR ~dEER L~AU~UT 1640 NI„RYAY 133 pAOYIA CO R1Y~, FACILITY LOCATION ->r ATTN: RELLY'PHItbLEd, JPE4API~JS N~3 NATIONAL POLLUTMT DISCNMOE EUMINATON SYSTEM /NPOESI DISCNARGE MONRORINO REPORT lOMRI l2-761 17-791 C7.;8$0029 P RMIT NUMBER DISCN GE NUMBER "~ MONITORING PERI D . ~ VEA MO DAY VEA O DAV FROM TO ' - !242 31 !2615/ .~ IT627 !TB•291 !36311 Fonn Approved. DUS!~UT POND TO N ~illE°•~,lAA43~OH (SU3R YC) APProvd elc~~~05-31-98 P - FINAL LL !lINI1E v## NO DISCflAP,GE ~)~~ Srr NOTE: Reed Irotruetloro before completlnp th4 form. PARAMETER l3.Gro On1Y1 QVANTITY OR LO 0 ( ' OnlYl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE l~6531 .! 51 ^ d3B•151 l~5-53 1566/ EX of l32-371 AVERAGE MAXIMUM V ~ MINIMG~~' AYERAGE MAXIMUM UNITS T-e~~ MALY95 l~-Qg/ TYPE I5g70/ u~ 55 SAMPLE Y:~~C~ ~ ( ~## #~ '~TA# ## G.°•#r-".-'.- ISUeL MEASUREMENT -.~ ~ 4US6 1 U J PERMIT #3r;.~.::; -.` ::,:"" : ES=1 "~~~#?~.: s;::;:i~:..~L": #$~.Y#~ - ... ' BEKLY ISUAL I . EYFLUENT ~r2~j3 JALJ.t REQUIREMENT . ~ ," ,: .: :": .:.; ~`~ :.~~.~ ,: • :r :: <;. SAMPLE ~ ~ " MEASUREMENT ~ ~'' j _ .. ~ .PERMIT." ~~ , ~ . t .. ~," ~ ~~~ ,._ - ;,,, ..:, ~ . " REQUIREAA ENF: :.~. .. . . . ... ... ..:.. ::. ~ ".?: ~~ ~~j::•~' ; . . . . . SAMPLE _ MEASUREMENT ~~ ....~~ PERMIT - " ~• . . ~. ~ .. .: ~" .: SAMPLE MEASUREMENT PERMIT . ~ ~^ ` "::~ ~ ~ '" 9EQUIREMENT ~ .: "~ ~ :.:.,.. .`. .,.<~ :~;.~ , ::. ~. . SAMPLE MEASUREMENT ~ S ^ ''PERMIT i.::~.xte..: _... .;~~"~w r: 'AEQl11REMENT. ` ~ .: ..~~. ,';,.,:,: ~~~::..'~:;'i ':'::;"::.~ , ,err SAMPLE MEASUREMENT G ~. ;'• PERMIT ~~ ~:.. . .f ~,.. ..~~.;::.~~:~ ."~ ~" : ~" ~ ~'' ' "REQUIREMENT ,`~~ . : .. . :.:,: .= . SAMPLE ~ ~ - MEASUREMENT '. :.: .. . ':':: F.i :.:: c: : EQUIREMENT:: :.... ~ .. ~ .. ... ~:.:. . .. . .~. .:: :.^: :'. ~ .:,.n.5:::~:'.,;:.,:e:.~...": r:: '' :: . NAMERITLE PRINCIPAL EXECI7TNE OFFICER I CERTI AM FA FY UNDER PENN.TY OF LAW TNAT I NAVE PERSO MIUM WITH THE INFORMAT SUBMITTED O NALLY E%AMIN EREIN D BA FD MD S ~ " TELEPHONE DATE I N H ; M MY INQUIRY OF TXOSE IMDINDVN.S IMMEDIATELY RESPON9B ED ON LE FOR ' OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMA TION IS TRVE. ACCVMTE MD COMRETE. I AM AWME TNAT THE 9GNIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION IN RE ME CLl1OING X Ke 1 1 Fritz 1 e r , THE P059BILITY OF RNE MD IMPNSONMENT. SEE 18 U.S,C. r 1001 MD S] BION E OF Tnr L E 970 929- 5855 99 ' O 2 1 IYPED OR PRINTED ~.''~;,~wn r«m ~.~ ~icA~lr~~sW ro tlo,GaD A xECL7 E OfFlCER OR HORIZED AOEM A A NUMBER YEAR MO DAY CODE o.w nnv cnr cnnn nvn yr n vlvcn nvna In...Tmc. an smcnm.nDS nrre/ SETTLElBLd SJLI05 LI!1IP APPLIES ONLY IF := 10-YR, 24-RR PRdC1P l;Yy~NT IS CLAItlED. I?°..fVLAI[f APPROVED BY YQ_D,,TSS :. IRJY LI1IP3 GILL N7T dF. APPLIED fJ REPORTED 16ASUkElSEYTS--S E I.B.1AF ~6r°.~'~~D L B.1D, PG 6. EPA Farm 3320.7 LOB-951 Pnvlous etlitions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT