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<br />PERMITTEE NAME/ADDRESS (1wAr4 FSrGryNa/Locanm 1/DIQr.wu) <br />NAME II'.6PI'i ~i "i~I dG, _. <br />ADDRESS T !S A'c' {I F; :; p T ;; E <br />P.U. E~~% 117 <br />C i/A ~~ GO r.162u <br />FAaurv <br />LOCATION <br />n Iii.. w • uOF.U )i. t :: C^~6C, ~dF ~/GRl. :', ;,R <br />NATIOIIK POLLIfTMT gSCHMOF FUMINATION SrSTEM //NPDESI <br />DISCHARGE MlN11TORINO REPORT /OMR) <br />17-161 17-191 <br />00003211 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM TO _ <br />IJQ1fl U7-731 114751 /16171 I7B-19/ 136311 <br />Form Approved. <br />ACUTE fIET TF-:,?Z.aG°Nlscf{D-{o~aooa <br />(S fi E F A M) APPravelLe>~lrsq 05-31-98 <br />F - F1t~AL ff <br />'INCA <br />NOTE: R••d In•tructlan• b•for• eompl•dnp thi• fwm. <br />PARAMETER 13 O.J on1N QUANTITY OR LOADING Is Gro Onlrl QUANTITY OR CONCENTRATION ND FREOUENCV SAMPLE <br /> 1~653I 15x-51 I3B-I51 !•653 /5r-sll EX DF PE <br />/37-371 MKVSIS TY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /eJ-sal 15I-581 1s9-701 <br />,. i:!J STATei E: 4RNf? At' SAMPLE 444 :r.^^•': +: ~`r,:44~ r; f, f}t{<:Y r, O:+-{~r.:~ ( <'3) <br />L: :. f: I OD AP.`I N I A MEASUREMENT <br />Ar,lu 1 U C~ PERMIT . 4#C~RiE:7 tL~l?!~+k~F >ra# 100.. A~CgQ:4 . 4~71ii+6ry4 £R- TkL:Y ,-ifAP <br />;.F'FLUtihI' GRUBS VALU' .REQUIREMENT OJ~>.• [(a)i::VAIU$ <br />.... r <br />.. <br />., L'SU STA IEi F: 95f'I'. AC' SAMPLE '-7.D:y:1# St:k{. (ipt~ ~ Og03-0d A :x044 t 23) <br />1'I::EPiI~LiS MEASUREMENT <br />~CrI'roC 1 0 0 PERMIT *}Xr~ ~.Ip. ~: :~,.~!Y~'.?9r41R1k ~ 444 .140.., .: ~ ~~ta.~Y:#At+.~ .. :~::40~;i~~>+lXf,~.~ ER- ~.. -.7`.t?LY ~.~itAn <br />.f FLi;aNT ;,ROSi VALU, .REQUIREMENT ,;;:. :: y14y:4 <br />?1~R.: Y.i I I7 i CFA <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - "" ---- ~ ~. <br /> REQUIREMENT <br />` <br />- '- SAMP <br />MEA EMENT <br />~ <br />5~,,~f <br />G <br />- ~y~ <br /> RMIT - ~ ~~ <br /> REQ NZ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ ~ ~~~~ ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ , <br /> REQUIREMENT : <br />NAME/i1TLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY uNOER PENALTY OF <br />MILIM WITH THE NIFO LAW THAT I HAVE PERSONALLY EKIV.IINFD MD <br />RMATON SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> MY INDUIIIY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />~ <br /> OBTNNINO THE INFORMATION, I BELEVE THE SUBMITTED INFORMATION Is _ / / <br /> <br />W• Gordon Pacers <br />TRUE. ACCURATE MO COMPLETE. I AM AWME THAT THERE ME <br />AGNIFICANT PENALTIES fOR SUBMITTING FALSE INFORMATION <br />INCLUDING • <br />G.J G <br />9]0-824-4401 <br />98 <br />4 <br />28 <br /> . <br />THE POSSIBILITY OF FNE MD IMPIIISONMENT. BEE 1B U.B.C. ! 1001 AND 33 SIGNATURE OF -RINCMAL EXECUTNE <br /> u.s.e. E f al •. arrlrol.. enen 'row mlunA +*rr AxAAF A,.. w ro r ro,000 <br />TYPED OR PRINTED wnmvirern irorlA»+r.+r o/awwn smsrtlxwsrra/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION of ANY v1oLA nonS fH•r•r•nc• ur •mcnm•nls n•r•1 <br />.,GS. i.h.2, PP ]-9, f'CF. L'%TAILS JF Ti5T PnOCEGGk°. REPJYP LC°C - I7A?I~TICAL fI~iT F.TIr,AT?: vtliCrl I5. <br />„~ThAL TO SUY UP TEST JR.,A!sISY,S, AND ATTACF ACUTE TUXICIfY °.'_ST PEFCFT F(F~ TC CM°. CU~I":S Uc' 4LL <br />.yl ~T v o ~ r r o <br />EPA Fwm 3320.7 108-951 Previous editions may be used. (REPLACES PA FORM T 0 WHI AY NO BE USE •1 n 0 c 5 8 / a P C 11 3 -1 C ~ C+ I <br />ff '4', <br />P, <br />f' ' <br />