|
P$RYRTEE RAYFIADDRE58 (lwduh N
<br />FPrUUY Neese/Lnerrbn U 6UIexeU
<br />NAME HDC~ifbS:PLESL4I.H E'_J,STFid $SY... fa.d~__
<br />'DRESS ~NNAHIS2EILLHASII.NGLlSACIlO.IIfi]._ .
<br />---f'1'^H^VE_CeEAYTSTT1~DlLLBdLLBE.ESYHEYETZe_'C-I1 _?' .-.
<br />_Ae.Y LLi.LL ueLE-v--~-JL~~.i.iJ~ C ~ C
<br />LOCATION_ ~? "~ ~' ~FRI
<br />ATTNa DAYID :l. lfACDODGALL_ ESC. ~:: ~ r:
<br />D19GHARGE MONITORING REPORT /DMR1
<br />(J-161 i (17•!91
<br />PERMIT NUMBER :. _ r DISCNARGE NUMBER
<br />":I YEAR-I MO I 'DAY I'~ ~^ I~YEAR I MO I DAY I
<br />F - FINdL
<br />PIT i2.DSCHHG TO GHdSSY CHEEK
<br />,;
<br />1" '
<br />C
<br />HIHOB (SUBHSHH)s.H00TT
<br />NOTE: Read Instrucllone before completing thls form.
<br />r -'
<br />`~ l3 Card Only/ ~ QC•ANTITY OR LOADING q' j~ .~
<br />3
<br />~ ~h~tdOply/` QUALITY OR CONCENTRATION
<br />~
<br />I
<br />NU! FREOUENCr
<br />SAMPLE
<br />PARAMETER ~ /16dJ) _ _ r
<br />(54611 u b' __ ~ _
<br />L
<br />/38AJ1: 116-JJI.. /J1-611
<br />`
<br />EX _ TYPE
<br />/J7-371 j ,? - ~ AVERAGEt~i :i ` MAXIMU ~ ..
<br />I+la ~
<br />m UN
<br />I TS: _
<br />u MINIMUM ~
<br />AVERAGE ~
<br />MAXIMUM _ +
<br />~
<br />UNITS -
<br />65
<br />6! 'ANnLrs15
<br />68
<br />6940
<br />~ 7 - _ /
<br />. ~ 161-
<br />1 /
<br />(
<br />PH ~ '" J O'SAMPLE _ ~#####I L~
<br />v ~#O~ii###~ ,`~ ~' ;, ~ ~ .` ######
<br />I •^ _,
<br />~
<br />:
<br />u ^y
<br />_~ MEASUREMENT: ~ ~ 5 ~. ~ ~i ~ u
<br />
<br />' a L I ~ I _. ` . . I
<br />0040D 1 0 n0 J .Y'-PERNa, y
<br />EOUIREI~NT
<br />` 4##7G ~'
<br />* #~ 'G{f (
<br />e-. '# ~
<br />~~~~q{~` ~
<br />~ §
<br />g~ '9A0 -0
<br />-Ir,':.. O '~
<br />~ t
<br />yC'.E/
<br />HdB
<br /> ~
<br />,~ Y ~
<br />~
<br />SOLIDS, .SBYTLEABLE'' ~ ~ SAMPLE' ii .:il#####: om'.`#Q####~ ~ m i -~ '~¢ #?~## ;; ###?Y## '• _ I
<br />~ ~~ Q MEASUREMENTL i ~ u ~ - 'O b, 1~ y i ? 'Z -~ CJ I 1f tj 7
<br /> ~ ~
<br />00545 1 . 0,'.~ 0 ~ PETiMQ ,~
<br />E NT
<br />EOU +p##'EI Y ' p~# ###
<br />' ##~ ° #7ti ,;### ~##q##o~
<br />+~ :py ~-
<br />y
<br />.~ ~
<br />L -
<br />•
<br />r,
<br />CE/,:. H;dB
<br /> ~
<br />JB
<br />O ~3j'
<br />~,. fi ~ #~# #) 7 ~ C ~
<br /> . . -- !
<br />OiL dtlD,GHEASE '~
<br />~ ~; SAMPLE N :##~~##: -~ ,:#~##.~#j 6 ~' y •~~###~-
<br />' ,######
<br />~ `~
<br />... "
<br />-
<br />O - .
<br />~
<br />
<br />PHEOtl EZTB=GfidY~HET MEASUREMENT.. p +~.. n u r" O 7 r
<br />a ~ , nP n
<br />1 ~
<br />T `
<br />' _, j lcy I ~ , ; i
<br />~' I
<br />00556 1 ~0' "0 ~ ° ,~'PERMd.' s . ~ ## ~. ### ~. #T~#~##~ #16Q '"~t'~ 1 L` s .d' 14T EdB
<br /> ~
<br />I HOH O ~_. `^ ,day ~° SAMPLE ;,
<br />MEASUREME
<br />T '######:
<br />_ '>q ~##~#r-
<br />C ~' ,~•C i 1S '~##~####.
<br />~ ::#~#### IN
<br />( q - ,~ :~ ''
<br />l
<br />TOTdL fiECOY
<br />EHABL~ J N
<br />~p ~
<br />~ ~ ,O O O i ' :
<br />I~ ~ u, O J• '_ +r ~ J p
<br />1
<br />00980 1 ~ 0 x0
<br />~ ;. ~OPIRp~E1~ENT~ .v#~!~#Q ,
<br />, O
<br />#g# ~ .~a#
<br />4#'~ : ~# °~,`-~ :OP•TdONLL , ~ - - = OHTIE BAB
<br />' , ~ ~
<br />PLOY, Itl cCOtlDOIT OHS t SAMPLE ;.:
<br />MEAS
<br />REMENT ~'.:Ip###4i!`. •~• ~+ p~p .~ ~
<br />' ~
<br />~ ~ ~ ~ ,o##~##. r ,~4#### i######
<br />1'tlHU .THEI~l1SlIT'PLAH U
<br />_ ~ ~ I ~ N i+
<br />y ^, I C
<br />~ ~ ^ 7 ~= ~ ~ ~ * "
<br />.. ~ Y-f I "'1
<br />1
<br />50050 1 u a '•D ~ y~ry
<br />~~pEOU
<br />EMENT {~ 7~ /~q
<br />TM
<br />~
<br />U'
<br />~
<br />A~~
<br />~ r, ,
<br />j
<br />S ~. y+ ~
<br />A~ ?#'Y"# q
<br />#~:
<br />#~~
<br />`..~#~~ #S
<br />#'~'•~ ~
<br />', ~
<br />~CE/~!
<br />HSTAN
<br /> lR
<br />A
<br />W .
<br />r
<br />.
<br />I
<br />.
<br />T.. ? ~1 ~- ~ 7 ####
<br />SOLIDS, ZOlAL' c: •C SAMPLE ~ ~-:~#~$#~` ~. V###±~iy J .u -. ;~>x#q##' ~ #~t#### Y ;: -
<br />'1 LJ
<br />DISSOLYSD, T . ~ MEASUREMENT^
<br />_ p ~,
<br />~ i < 5
<br />T m
<br />~
<br />y
<br />, ~ I= - ~ ~
<br />~
<br />.. ;
<br />I I r -
<br />.: '~ +
<br />- '
<br />70295 1 -'+Q ~O
<br />a M ~ Q
<br />¢, ~y~~ T ## ~i #
<br />~
<br />yg{ #4a ~
<br />~ :~#o # # a
<br />`y,
<br />, # +i ## ~.
<br />y ~ ~
<br />~BBPOHT ~ ._ :'
<br />~ ~ . >
<br />q
<br />~HLY.
<br />BAB
<br /> ~ ~ ~ p ,
<br />
<br />OIL ~BD.G~11Bd.SE F ~ ;~ SAMPLE ~
<br />MEASUREMENT ~ :~';#x+6+0'##•
<br />~ ~ o ~'r ~ ~ ~' } , m ;#' #### ~~ ##?~##t ######
<br />
<br />8406 1 ~~ Q QO = ~ ~~EDP RE E711~ ~ ~ Eg' 1 A ~~ ~
<br />~~~ p
<br />~ A~ 4
<br />'####~ #.; #o~ ~ ~ MCB/ ISDAL
<br /> . # I .
<br />I: E '
<br />NAMErTITLE PRINCIPAL EXECUTIVE OFFICER,'
<br />
<br />~ _ '1 CERTI
<br />`AND AM FY UNDER~PENALTYAF LAW :THAT I HAVE'P
<br />FAMILIAR WITH THF
<br />INFORMATION SUBMITT ERSONALLr
<br />ED HEREIN; A IXAMINED
<br />ND BASED " _ ~ :f
<br />7 jTELEPHONE DATE
<br />'
<br />_
<br />t!•1
<br />~• " `t~
<br />Karla Rabulk ~ TC
<br />? ~
<br />~ON MY INQUIRY OF TN0.4E~INDIVIDUALS~IMMEDIATELY •RESPONSIBLE.F
<br />OBTAINING
<br />THE INFORMATION
<br />(:BELIEVE TH
<br />SUBMITTED I
<br />F
<br />T _
<br />L` ~ - . _.
<br />~
<br />it .•. _
<br />Vice~Presjdent ~~ 1 ~
<br />L i
<br />.
<br />ORMA
<br />N
<br />E
<br />H
<br />IS TRUE, AOCURATEtAND COMPLETE"( AM AWARE THAT TNEREARE S ~
<br />4/1FICANT PENALTIES FOR.SUBMITTIaG+FALSE'INFORMATION, INCLUDING
<br />~
<br />~ ~
<br />
<br />SOS 754-2291
<br />~'
<br />92
<br />
<br />~4
<br />
<br />23
<br />~ V p ;~+
<br />,,;~ „ G LiHE POSSIBILITY OF'FINE AND IMPRISONMENTy~SEE iS:U.S.CtiI `iD61:AND
<br />(~.7 US.C. II 1618: (hwltp wM;IhgfsmA
<br />i(a IMyllgdude'fLttsyOrlo !/O
<br />OOD :. IGNATURE OF PR CIPAL EXECUTIVE
<br />t i
<br />_
<br />r] TYPED OR PRINTED ~ '~• ,
<br />,
<br />,
<br />~enewmuMwn ltrtp4°nmMt yBenvnemmtban0lymnl
<br />FFICER~OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />VVMMCM~ NV YFYLIIN/111VN Vh AMT VIVLAIIVN, /NLJeanR n/f R(!(KATMOAlR1 ~ ~ _~ ~ , I
<br />,OIL EyGSEASS' .SEE FOOTNOTE P/,,'PAGE 3 OP_THB'PEAtiIT. !POHHEHLY DISCBAHGED ONDEH CO-0035653..
<br />' i ~~
<br />EPA FOrm 33247 (ReY. aBB) Flex/008 ed/f/OnE mey be USed. (REPLACES EPA FORM T.b WHICH MAY NO7 BE USED.) -~
<br />00017/510123-1657 PAGF, i OF
<br />
|