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PERMITTEE NAMEIADDRESS prr4 FsWryNw/faauw UDlp..w <br />NAME TFiAFH E": "I~:.Y :;, I'.L, <br />ADDRESS T fl A P P E r. •' T '~ [. <br />F'.U. f::k I`7 <br />C3AI~ Ct7 Blo2b <br />FACILITY <br />LOCATION <br />': Ty: N. GORDOS PE?Er`, PitE`i/GEV h;, ;; <br />NATIONK POLL 7pSC{~~~ E ELIMINATION SYSTEM fIYPDE$) <br />DISCHA~FJYIONITORING REPORT fOAIRI <br />Y-lel t7-f91' <br />00003 1 C11 A <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />!2621) l22-231 12I-251 !26271 129-29) !3031/ <br />Form ApproveD. <br />F O N D ~: T o e A s r F~IB~NpTZOCo,~eoep <br />{ 5 U P P 4'~ ~ APProvelle~~rgy-05-31-98 <br />F - F[h~L <br />'Iryrc <br />~'~ ~'C U.?SCHARGE I~I r'''° <br />NOTE: Reed IMWCt1oM be}orr. compMtlnp this form. <br />PARAMETER !3 Grd Onlp QUANTITY Oq LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION . NO FREDUENCY SAMPLE <br /> /I6531 l5ie11. l38-~51 !1659 !5r-e1 DF <br />132-371 <br /> <br />AVERAGE <br /> <br />.MAXIMUM <br /> <br />UNITS <br /> <br />MINIMUM <br /> <br />AVERAGE <br /> <br />MAXIMUM <br /> <br />UNITS EX <br /> <br />s2-esl <br />MALY515 <br />l6F-5e1 TYPE <br /> <br />le8-7o1 <br />~ N G E SE: SAMPLE a;,saaa ~ gq~ t?Ot4d09 kCi+~t+9 Oav~+aa <br />Y 15 U A L MEASUREMENT <br />~4U6d 1 U 0 P~gMl7:.: 'G~uG '<`>~ REI?Cilt'!.. F'S=1 !rAd44fi d4>e+F4f~ "aot'fiA?Y a#n EEKi,Y ISUA <br />cF'F'LUENT GROSS VALU REQUIfIEMEN7 ..'.' . .: ::: ..... ..~1tS'R ~fYX= MG~O :..::' %;. <br /> <br />::. >Ah><ti# ; ,. <br />.. <br /> SAMPLE <br /> MEASUREMENT ~ ~ ~ - <br /> :::: <br />~.:P <br />MI. .. ..~ <br />,,,. . <br />• <br /> <br />' <br /> _ . <br />..:.. <br />: ~. <br />E.. EME.II{3". .:... .. .~:.:..:. .. <br />... .~:::... .' <br /> <br /> <br />,, <br />s <br />~' <br /> <br /> <br /> <br /> <br /> <br />::;~: <br /> <br /> <br /> <br />:: <br />.. <br /> <br />... a <br />:. <br /> <br /> <br /> <br /> <br /> <br /> <br />. , <br /> PLE <br /> (v1EASUR MENt ~// ~/,,f~ly~ ~ '^~; `µ- <br /> •PER... <br /> <br />~ <br /> <br />~ <br /> <br />~ <br />j•iAM't <br />" <br /> NEQUIREMENT ~ .. : <br />.... :£.. <br />. ' <br />,k".C <br /> . a: <br /> SAMPLE <br />~ / <br />~ <br /> MEASUREMENT ~d~K <br />~ FFF <br />a PERMIT ~~ ~ . <br />~ ~ .... .;::.. <br />- ~REQUIRENIENT ~ <br />;:. , .. <br />~ .... ,' ~ ty.' .;; :;` <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />... PERMIT.:: .::. <br />...... .. . <br />.. ... <br />.,::... .. <br />;. <br />- :REQUIRE.NIENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ . ~ ~ - ~ - <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMINED MD TELEPHON E DATE <br /> AM FAMIIIM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON <br /> MY INOWRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />YL• ('a0Ia00 PeteLe OBTAINING THE INFORMATON, I eEIIEVE THE SUBMITTED INFORMATION IS <br />Q <br /> TRUE. ACCUMTE MO COMRETE. I AM AWME THAT THEpE ME .- <br />?resident It General Mena e7 <br />g SIGNIFCMT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLIAIND 970 824-4401 99 1 25' <br /> THE PpS51eIDTY OF FINE MD IMPRISONMENT. SEE tt U.S.C. 1 1001 MD ]] iIONATUNE OF MINICIPAL EXECUTNE <br /> U.S.C. f 1718. lNrn,!GY. uW ewr IYIVNF my YK.Yd. rxr. w ro J IO,OQ! AREA <br />TYPED OR PRINTED wo.mvYm,Ir bIFrlAA.nNN OIAFrwFNrlmmerFWeywt/ OFflCER OR AUTHORIZED AGENT C NUMBER YEAR MO DAV <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRefersnce ell etnchments hsrsl <br />:5~ 6 Tui'AL IEtOt• LI!M1ITi iiILL 9E +AIVED, ANU SETTLEAPL~ SCLICS I7ttI7 AF FLIED FCP. C-lOYR,?U9R PNClr EYNT- <br />_EG dURUEN OF F2CGF F.&jULRf"BNTS UNDER I.A.L. TDS MONITDEItif, - I.P.3. CIL f, GFFASE - SF.k I. E. 1.(D). <br />r <br />EPA Fwm 3320.1 108-96) Previous editions mey be used. IREPLACE6 A FORM T 0 WHICH MAY O BE USED.1 0 0101 / 9 7 ] 211- l fi 4 6 PAGE ZOF L <br />