|
PERMITTEE NAME/ADDRESS pndi6 fsNrryNaw/L«anw JOb..n9
<br />NAME IF.tidt't..r E:I'•• I..,,,
<br />ADDRESS + is n P L :: i. ~ ,.
<br />~~i~..,
<br />FACarn
<br />LocnnaN
<br />i.'.1 ~ ~ t i -~
<br />
<br />NATIONK POLLUTMT DISCNMOE ELIMINATION SYSTEM /NPOESI
<br />DISCHARGE MONRORINQ REPORT lOMRI
<br />7.161 17-I91
<br />::OU 32115 C17 A
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM ~ TO r. _
<br />!76711 /77-131 /71.15/ !76771 178-791 !36311
<br />Form Approved.
<br />F U 1 C F F/~ Z N E k t" 7gMFQ{p*2oRologog
<br />(S l; F F. 1'..) Approvellaxp~r$AOS•31-98
<br />F - FIFA!
<br />rI!.f-
<br />NOTE: RBBd InBtrueOonB brforB complrtlnp this form.
<br />PARAMETER !3 urd OnlYl QUANTFFY OR LOADING !1 urd Ontyl QUANTITY OR CONCENTRATION NO. FnEQUENCY SAMPLE
<br /> (46-531 151-6f) (3R-151 11653) 751-67)
<br />EX OF
<br />TYPE
<br />I37-371 µKY515
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s7-eJl 161-681 159-701
<br />r't: SAMPLE ...•,: r; :};: s+:'4#:} ^ : ata .':-:` ( 1 Z) ~
<br /> MEASUREMENT ,G ~, A9 ~ , iv1/Tr
<br />:~u'-I C'U 1 0 U PERMIT %~##' RO . : >.}XtatYt. # 4#:: t)i.cf ~~ ~ 4CQCG>n` ~4,t: ~ ~ ~~ i.'. £3(LY IASIT'
<br />i:c'FLUENT GR095 YAL17 REQUIREMENT arCt`~ p{.,~A[j~ipE. ldx:jMt171 ~U
<br />~~
<br />~J i S, 1'JTAL SAMPLE •••~ k-#=k #~A #.1i #.', aaOaaC ( jg) /
<br />., U :i ? c N G E: D ~~ MEASUREMENT L L ~ /~v ~,~',
<br />uU>>U 1 0 0 .PERMIT :,"+#I. f.l.E Ilat: Oat: 4.#>a. 09 3.~... .. '~~ NCf:/ ;F!AU
<br />:: F'YL08NT GROSS YALU, REQUIREMENT ~ -
<br />~ #>•, {:.:e ~ ~
<br />~ ". 3Ot i* A@G. :'G..A :. 'A ~tIY MG/L ~~ [70NTH
<br />-,v 1 , .. -. -. SAMPLE ~ :: ;rG4 S~#
<br />,YR~.`--:` #aoco; ( z$)
<br /> MEASUREMENT L p, / <v, /
<br />00`.:45 1',G 0 PERMIT ,..,."•=x:f ~ ~ #:,zY,cG## ~ #:%~: r.''i~ri#~~ CFTICAAL FF;FePT ~ NL:E:/ "~~RA6
<br />;,Fr'LUEV'f wp5 YALU -.REQUIREMENT 4aY:8 3C[A~ lYr.- >CAT~lY ~x "L/G ~ ,yor+'I'w
<br />. SAMPLE .-.: .t ::: ,: :: -':S,c#g:k:A aCCtG•'. ( 1'I)
<br />~
<br /> MEASUREMENT
<br />'=10th 1 ~ U ~ PERMIT X''rrlR :':k ~ 3Cl?3~Ys as;: #"a Gaa# ~PQ f; :.d- ~ NC E'/ '~°A9
<br />;. F'FLUENT ~GROS`' YALU. REQUIREMENT ~ ~~:."
<br />~ aA#4 _
<br />~ ?CCA Avr,~ r.A~r~1~T Mx ^;G/L ~hOt:T4
<br />U ~ SAMPLE ~ww• #'>'#4#CI :1Ca:ifia >rcaaz'e~ ( ]q)
<br /> MEASUREMENT ~yy gyp ~yj~
<br />'.; J~Ul 1 0 U ~ PERMIT ys .- ~ a'G:ASr C'0;= #~C'~A+'1C OCCs64>i ., .I.~...: .. ~:..~~. O>ltT I![ :4AE~
<br />,.:'iLUENT GROSS YALU 'REQUIREMENT 4•'.f:#
<br />.. ~ tIY,~~:.llA'x "f~:/I, (:F'NT
<br />y
<br />r i~ w, ~ 1 'J F. SAMPLE ( i1J) aa>ova>;. CCq##:k a;y#:: Y=
<br />11tJ ';::EATMENT PL A F MEASUREMENT U,/~(o!~ v,~ ~ ~ ~ ,..,/Jy.,,
<br />.„J sU 1 d (' ~ PERMIT Ei ~,:'C+~d: ~ 3EPURT .LT s~~"vritiA O~ifiiQ!l.r' ~ ~. ~.+?t`t+C..# :k :k l;: 'f. ?;LY I NiTA
<br />LUiYT GF;OSr~ YAI. (' REQUIREMENT 3{1 I:A 4Y„ RAILlf MX i7 vU
<br />~ ~ *=k':#
<br />., .!4a F SAMPLE .. .. fi'k ~#:k ~: a ~ ~X ( 19)
<br />~~SULVEU MEASUREMENT ~~/J , ~~ ~
<br />1.;95 L v PERMIT ~ ~ •~ -+ [F CRsA.L F c T T L ;I;Ae
<br />r:: FLUENT' Gk05i YA L.1: REQUIREMENT ~a.Aa ~ ,f,FT F~.d~~'C CAIN C"X t:;/L
<br />NAME/TFRE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF
<br />MIUM WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINED MO
<br />RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESFWNSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS
<br />W. Gordon Peters TRVE, ACCVMTE MD COM0.ETE. I AM AWME THAT THERE ME
<br />INCLIAIMG
<br />SIONIRCANT PENALTES FOR SUBMITTING fALSE INfORMAT10N 970-824-4401 98 4 28
<br />P e ,
<br />THE POSSIBILITY Of RNE MD IMPRISONMENT. SEE TB U.S.C. f 1001 MD 3J BIONATUIIE OF fM11NCN'AL E%ECUTNE
<br /> U.S.C. f 1 J1 r. !h/WniF N,dM Nrw NNNF rr,FY heArl~ fw, W ro t 10,000
<br />TYPED OR PRINTED .+dwmuinue Yrpiwnnrn of Mrrwn BmonN,rq BYwa/ OFFICER OR AUTNOR12E0 AOEFR CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rrfrrrncr N/ rrochmmfs hurl _
<br />;.;~ G '1J'1'.4L TkJ!: LI"?T.i aILL _t- ~AIL'EJ, A.Yp iLTPLEiIHL.^' `i7LICS LTNIT !IFLITC FCF C=iOY~,!4HR PRr^_IP ~=Y~'NT-
<br />,c% ©UItUiN `)F i'ctOOF' kE,lUltiF:4k,NT:i JNOi.`t I.d,3. TGS ".0`T'"ORING - I.F.S. !~iL f GFSASF. - Sir I.P.1.(D).
<br />. .~.TY LrRp L.'.N Tt; NTCR?:T MIlNTN1Y BMLOICS i"iL~IN DGDTTY TI OC DP C"'CT
<br />Epp Form 3320-1 108-961 PreviouB sditiom mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE U6ED.1 (? U ] 6 9 / 4 T ] 21 ] -1 G 4 F. PAGE LOF
<br />Z
<br />
|