er.......~:....,...~..SS / hde
<br />FACILf1Y __-
<br />~oclfnoR _ _ _
<br />.omc. na at
<br />( n~
<br />nml o
<br />S.TLES.~.,TIIE_1GH6SS~ ~4..
<br />Y1S$EZLLBAS$il1G,[!laCIlOiIf,AL- -
<br />~S= RITT-Y9UB EE S?$EF.T_._ ~~,1 -~ .~
<br />V
<br />i______ ~~ __ ~t _ 1]~ -
<br />'e rArnnnr_ATr ncn_ •- -' ~~
<br />NATIONAL POLLVTANT DISCHARGE ELIMINATION SYSTEM (NPDESI
<br />DISCNAROE MONITORING REPORT (OMR/
<br />(1-I61 I /l7-/9/
<br />~ r_• PERMIT NUMBER ~ DISCHARGE HUMBER
<br />J
<br />ro
<br />F'-•FIYAL
<br />PIT tl'DSCtlHG TO GRASSY CAEEK
<br />- I-
<br />i~~ ,
<br />L. i _~ ~.: ~ ':.
<br />tlIAOA (SOBA:YY):~AOUYT
<br />NOTE: Read Instruetlons belore completing this form.
<br />
<br />~~
<br />/3 Card Only/ ' QUANTITY OR LOADING _ ~
<br />u
<br />/I Card On! ,
<br />yl QUALITY OR CONCENTRATION ~
<br />~ v ~ ~
<br />,
<br />~-
<br />
<br />NO: FREQUENCY
<br />
<br />SAMPLE
<br />PARAYETER~ ~o O i, ,, m ~
<br />(I6JJ1 _ (Jlfill .r
<br />' i _
<br />.,
<br />~
<br />(38JJ1 .- (ibJ31 IJI-UI/
<br />E%. DF
<br />TYPE
<br />(JI3`J
<br />,.i
<br />~ ~=
<br />m .L•
<br />AVERAGE, ;i '] ..
<br />MA%IMUM
<br />~ C
<br />n`. UNITS'. ~~
<br />~
<br />~ MINIMUM AVERAGE MA%IMUM ~
<br />`UNITS '
<br />(6743 ANALYSIS
<br />i 161fiB1
<br />(6LJ0/
<br />v -, _ ~, ,_ ..
<br />~
<br />PY V " - C'SAMPLE. ,~; ~#~#'•IX#= U'######,'~
<br />i) ,~ Q , V
<br />" ~
<br />- r ###### i p U :_ L. (
<br />Pa
<br />~ ~ 3 MEASUREMENTi ~~ I :.I V
<br />~ u A~ r j ~ ~
<br />r ~ I _ ~ . ~ _
<br />:. - .
<br />
<br />00400 1 d =0 °
<br />'••.rERMn. ..,,
<br />'~~#~~
<br />~#7 #
<br />~
<br />###io
<br />6~ •!
<br />#~#~t~'-
<br />i~.#
<br />#
<br />~.0 $ W
<br />c
<br />~
<br />HGE/ .
<br />AdB
<br />_ EOUIREI.I~NT Q; I
<br />?i ~}~.'- ~Er.r, ~¢ ####~i 's. ~~
<br />,
<br />~f. tt' SIK -.M t=, I
<br />J ..'t I
<br />SOLIDS, :SETSLEeBLE ~ '` sAMPLe' G ,###### ;-'~#~####~;
<br />`~ ° lao ~ ##
<br />O
<br />~ ~1### ;; .###### ~. ~ ~ ~-
<br />h ..
<br />~lt J 1 MEASUREMENTp _ ., i !
<br />? ~ A (~ I~. n 1 ;y ~. f ': a k .
<br />00545 1 . Q: ~~ O ~ PENM a
<br />I
<br />p # #?~•"' ,'vi.
<br />~
<br />~ # ### ~ ';_ ~1{~ ## #~ ~ ###### '`
<br />.
<br />}
<br />".
<br />' ~W''~i ~r ~ is .. ! ^'(
<br />r• JBEfLENT
<br />.~EOI 1'%'>
<br />~ `tu ~~~
<br />~ #~##i~ 2i .-~I ~
<br />'~ , Ak ~ z~
<br />;
<br />~+
<br />~
<br />OiL eYD:GBEASE
<br />'n n'SAMPLE' ~. ####~#: -' ~:#3####~
<br />. ^ ~ -~'##' ##,##, $~#### ~'
<br />-
<br />I -
<br />~ ...
<br />
<br />~~
<br />.,
<br />FHEOY EIr~-GEAY
<br />sET MEASUREMENT V i . L^ P -I `~.
<br />._ W 7
<br />.` - a .
<br />a l - J-i
<br />`{ ~ i~; ~ wY ~
<br />~;
<br />00556 •1 c p' ' p ~ °
<br />} PERM~+ S
<br />u ~?¢####
<br />} ~ # :i##A
<br />~ #~# ~. ##
<br />y ' ?CI# ~ ;~#~#### ;70 I.. `.~,
<br />. - ;;' ~ 0 SIY
<br />° B
<br />AB
<br /> OU~~ppEyBNT
<br />_ ~ j y, J
<br />IBOY 7~_'. N ` } u SAMPLE ~' ,####,'~'+'}: C '_####~#v ~ ( ~ {T :##I ####. ######
<br />. L07
<br />T `
<br />4
<br />I ~ •' ., ~ ~; _
<br />1
<br />ESeBL'~E j
<br />TOTAL . EEC<Ov MEASUREMENT j T~ I '~?
<br />~ ~ W ~ ~ = O i ~ ::~.I :• ry
<br />(,_ ?i ~-
<br />,
<br />.
<br />- ~ u p :; ? O C '~' ,
<br />,
<br />00980 1 N 0.' b0 ffj' y
<br />~o
<br />e
<br />LM
<br />~
<br />~#~
<br />*
<br />~~~
<br />~#'~
<br />,,~a0>~~j##~.
<br />AP.
<br />Ol1~L
<br />K a 9
<br />#'~
<br />gATIB 1
<br />EAH
<br /> ;
<br />l
<br />E
<br />~NT~ ~$'~"
<br />' '~ ' •
<br />~ .
<br />' , ,
<br /> , : #
<br /># ~
<br />FLOY
<br />IY COYbDI'T OEJ ^L •`######~ s
<br />~. b ~ ~ ~ ? L##~`### ###### ~ ti###### ~ -'O i- _
<br />,
<br />2HBU lHE~}!~ElIT 'PLeE EASUREMENT=
<br />- - •' t= ~ ~ V
<br />`- ~
<br />~ m c. _
<br />a e' .. ?
<br />9 a, I
<br />. .
<br />~' ~ ~' ~ ; '
<br />50050 - 1 ~ d ~0 ~ ,
<br />M
<br />~ ?~ POE ; ~. ~ 4
<br />~~# ###~~#~'~' ~# ~
<br />k ~#~
<br />`' ~'~ CE/.« 6~STbY
<br /> ~~E
<br />M y
<br />~, R ~
<br />k
<br />p ~, #
<br />SOLIDS, TOtA31 /_ '1 SAMPLE lu ~'####,~#~
<br />- d I##'####.+ O 11 ' ~ 4##Q#~. a~ ##~#f# '
<br />I [ C ._ ['
<br />a ~ ~ ,~
<br />N
<br />DISSOLYEq; w o MEASUREMENT_
<br />_ Si ~ ;i '
<br />^~ ..
<br />;, ^"
<br />I ~ `4 ^i I `i
<br />F• p: :] t
<br />~: _~ •' ~I L:
<br />
<br />•
<br />'
<br />70295 1 ` p'• ~0 ~ RMIT
<br />- # a
<br />!a# N ~~
<br />~ #
<br />#~ ~ ; BBPO i o ~ . $J
<br />T~ ee
<br />>
<br />~ EY~NT ,
<br />'h '' O °
<br />' .
<br />'
<br />„
<br />- G,_ q B .
<br />• j
<br /> „ t{ .t
<br />^J. ~ _ #~F# ~• + h: `
<br />.~"- "T~~,?
<br />' .+
<br />,
<br />GIL D: ~p EASE L' :t
<br />~~ ~'
<br />~' nSAMPL u
<br />`
<br />E ~;##A###
<br />" a 5 ~• p ~ ,y
<br />^~ ~ %. I
<br />. I '~
<br />v ;1e ~i0##?tr##
<br />~ ~e ##A~### ###### -
<br />~ ~ ~
<br />=
<br />3 -- _.. ~
<br /># MEASUREM
<br />NT .
<br />- t ' j - ij ^
<br />- ~
<br />i
<br />o a ~
<br />84066: 1 a 60.0 "I a• ,,,t
<br />.'V~IiAIL*''~ o~
<br />~
<br />#
<br />I v ~~s`
<br />EIS; ~' ~;
<br />~
<br />~ ~###iF v
<br />~## ~ ~1~ lIC~E/ ` ISUAL
<br /> ~
<br />REYENT °
<br />;~t
<br />"- 1' `
<br />Q E
<br /> .w .
<br />r
<br />NAMERITLE PRINCIPAL E%ECUTIVEOFFICER t~ -1 GERnFY UNDER PENAL7Y:DF iAW .THAT l NAVE•P
<br />•AND AM FAMILIAR WITH THE INFORMATION SUBMITT ERSONALLY
<br />ED HEREIN
<br />A ExAiAINED I' ~ ,N
<br />ND BASED
<br />r L: t•, TELEPXONE ~A ~~ I'. -~ DATE
<br />
<br />" l~
<br />c
<br />1
<br />r ;
<br />~ r ~
<br />I;
<br />O l~
<br />V
<br />I
<br />I
<br />~
<br />M
<br />O
<br />N
<br />•O
<br />~-
<br />~ _
<br />~'-' ~ -
<br />~ '~
<br />-
<br />, ~
<br />Rabu
<br />k `
<br />Kar-
<br />a
<br />~`• ~j (~ • ~ ~
<br />'~
<br />de
<br />i
<br />P
<br />t BELIE
<br />SUBMITTED
<br />FORMATI
<br />OBTA NINE T
<br />RE NFORMATION.
<br />I
<br />E
<br />THE
<br />.IS TRUE, ACCURATE AND COMPLETE:I AM AWARE THAT TNERE-ARE BID W(/l/l~
<br />(~
<br />TIES
<br />FOR 6UBMITTING FAISE
<br />INFORM
<br />TION
<br />INCLUDI
<br />F
<br />C
<br />NT PEN
<br />G _
<br />p 1.
<br />600 754=229T
<br />92'~
<br />04
<br />'23
<br />!!
<br />_~1
<br />ce:
<br />resi
<br />V
<br />h
<br />4_ ~j ;- b _
<br />` :NI
<br />I
<br />A
<br />AL
<br />.
<br />~
<br />,
<br />N
<br />~ ..
<br />A
<br />_Tp.H~E POSSIBILITY OF FINE AND IMPRISONMENT_~SEE 18: U.S.C~f =1001,AND IGNATURE OF RINCIPAL E%ECUTIVE
<br />D
<br />•J
<br />/
<br />d
<br />1
<br />l - '
<br />
<br />r7 TYPEDOR PRINTED
<br />'~ . f I
<br />1B. IPblllllY Wld[I al.ltSK1YIfJ IIIOY.IM
<br />Y
<br />,D
<br />' Y (l.$.
<br />f. f
<br />nR:MO[IO t/O.L
<br />-ineor mailman unpbanmenr a/Mrvvnamomba,d 31nv2/ ~ OFFICEfl OR AUTHORIZED AGENT
<br />NUMBER _
<br />YEAR
<br />MO
<br />DAY
<br />COMMEN,~ ND EL(PLAN9TION OF ANY VIOLATIONS (jteJrienfe allattacAmenv herel '^' -' "' i '" ' ' "" ' ' ' - ~ '
<br />OIL 8`'.GBF35E:'. SEE FOOTNOTE F/, PAGE 3,IY THE. PEAIlIT~.,~FOAtlEALY.DISCBAAGED OYDER CO-0035653.--__._
<br />EPA Form 33247 (RSV. aeaJ PlBYlOUB BO/IlO/IS /q8}~ AB USBd. (REPLACES EPA FORM T-M WNICN MAY NOT BE UBEO.)
<br />00023/910173-1657 PAGE 1 OF
<br />
|