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PERMITTEE NAME/ADDRESS pii.d. fsWryN.rLuanen+JD15G.w9 <br />NAME TtiAF'"E'r, "i'+. ~, - -. <br />ADDRESS Z rF A r' !' E ' - '' ~~ <br />F'. U. 'i:i 1~' <br />C ~ .~ : la <br />I-I~ °.1026 <br />FAaurv <br />LOCATION <br />:1'fT::; :. I, 0.4pJh f F'iEF:, ...i5/Gt "~ M, ;,R <br />NATIDNDISCNARGE MON TDOgMIC REPORT % MRIPDESI <br />/1-181 /7-191 <br />000032115 C1` A <br />PERMIT NUMBER DISOHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY ~ YEAR MO DAY <br />FROM i TO ~' _ .: <br />1101/1 l12-131 l1t251 116-171 178-191 /3031/ <br />Form Approved. <br />C? S C P A F~ .' T C !: P o rpMra No+Rosgfoooa <br />(5 U E F \ N) ApprovNl xp`rae; 05-31-98 <br />F - FIf•aL <br />rI"IG' <br />NOTE: Reed Irutructlaru belore completing this form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Grd On/yl QUANTITY OR CONCENTRATION ~ NO, mEDGENCY SAMPLE <br /> M5-531 /54-5! l3BJb1 !16631 IbbS! of <br />131-371 EX <br />V515 <br />MN TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS le1~s7 . <br />161-551 169-70) <br />J a. AN (: r. w.a~~ SAMPLE ,.:~{,G ~'~k 9µ <br />~ ~ aaa aT;f <br />#~~Dr'^: <br />O{i,K:vt-~ <br />JiSUAL MEASUREMENT U ~ ~ r~H{( <br />!iUUub 1 0 0 PERMIT.~~ ~ DfFYrik4t °~.PO~R'I ~ HS=1 a+aat?~>rz~ A#. +e+00# %••#;#~#a. a:k,; g:E~t'L~ YYSUA~ <br />t:FF'LUEt:T GROS$ YLLU FIEOUIREME.1{T:; ..'. 1`:~T 1'f~%:. NC=D 4"la'+4 ::. <br /> SAMPLE <br /> MEASUREMENT <br /> .":~.:QEJtMIT~~ ~ ~~ ~ ~~~ ~:~:~.:.~~ .. ~ ._ <br />. _ <br /> :REQULNEMENT <br />s/ <br /> .. ... <br /> SAMPLE <br /> MEASUREMENT <br /> <br />~ PERMIT <br />. ~ `REQUIREMENT <br /> SAMPLE <br />'' + <br />v MEASUREMENT <br />~ ,. PERMIT <br />~' ~ REQUIREMENT <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT <br />~~ .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ ~ ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> #IEQUIREMEN7~ ~ ~ ~~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cten <br />AM FM FV uNOeR PENN.Tr or <br />IILIM WITH THE INFO uw THAT I HAVE PERSONALLY ExAMINED MD <br />RMATION SUBMITTED HEREIN; MD SASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR w <br /> OBTNNING THE INFORMATION. I BELIEVE THE SUBMITTED INF011MATION IS <br />` <br />W. Gordon Peters TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFICMT PENN <br />TIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ 970-824-4401 98 Yi 28 <br />President/Coastal Maas er . <br />, <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. BEE 1e U.S <br />1 1001 MD a] <br />C <br /> . <br />. <br />u <br />s <br />c <br />E <br />a <br />n <br />v BIONATUIIE OF fMi1NCNAl E%ECUTNE <br /> . <br />. <br />. <br />l <br />i <br />. rAnw <br />....,w d.r wnm. mFr `.c,Ue. 5n.• w ro s/o.DPo <br />TYPED OR PRINTED wnmuhR..r i,r•,rman..«enw,u.wsr.ral OFFICER OR AVFHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRefereen d! ettechmsnts hrrN - <br />,55 t: TUiAL IEON LIMITS 4ILL EE aAIYF.D, A4p .iETTLEAHL° 57LIL5 LIFI7 AFPLIt~J FCF <=1CYR,~uI{u PF'F:CIP CVEhT- <br />_.Lf. NUkUF.N ~F' PROOF RS,IrtEnE:NTS UND53 I.A.3. TDS t!CNI'IO~INf - T.>?.3. ^II. F. CFF.95r _ acF. L.N.1.(u). <br />3U 'lAY AV6RA"E IS ./Tf; Ne_ST M(I1JTNIY eYF ~BrF nll FIT V+: yED Tnn cc r~ca bl <br />EPA Fwm 3320-1 (00.95) Prevloue edlDOne mey be need. (REPLACES EPA FORM T~10 WNICH MAY NOT BE USED.1 U ~ 14 (; / G 7 1211-164 F PAGE ~OF~ <br />