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PERMITTEE NAME/ADORESS (Include Fecil/ry Name/Locanon iJDifferenl) <br />NAME ~e:N ~;;A CulsL is O'1FhivY <br />ADDRESSp Z A~ E d U <br />Yi0.Y0tiN CD ti1b37 <br />FACILITY <br />LOCATIONI A Y D ~• N C O d 16 i D <br />0.I'CN: ;, oJu U9J:h, (.Ll~f'R0.L ,MANASF.R <br /> (3 CardOny) O <br />PARAMETER (46-53 <br />(3230 AVERAGE <br />J l L N J o is f. 5 .. SAMPLE """ <br />I:,7AL <br />~JSD 1 0 0 <br />FfL7E,.; ::ASS YALJ <br />PERMIT <br />FROM <br />MAXIMUM <br />O <br />h1~~IHE~MCNT ~ - e - . ~.;~"N. <br />SAMPLE <br />,MEASUREMENT <br />r <br />~~~ ~M~NT <br />~:d'4 <br />!; <br /> •`~ <br />SAMPLE <br />MEASUREMENT <br /> <br />Ya~ Eld ~~ <br />~T a { <br />9 ~ <br />- is ~ ~ , <br />I` { n <br /> _ <br />SAMPLE <br />MEASUREMENT <br /> <br /> <br />SAMPLE <br />MEASUREMENT <br />I <br /> <br />~.... , S <br />t "r.'. 1 <br />iti~ <br />.~ <br /> ,„ <br />SAMPLE <br />MEASUREMENT <br />"~`' ~~MFf` ~-- ' ~ r c <br />~i U1FifiA~~NT., _ ~, :~~.' ,.' <br />SAMPLE <br />MEASUREMENT <br />~F :' EI~NIF~' , ~ " ~ r. ., <br />9 V1AfiM~NT t <br />31SCHARGE ELIMINATION SYSTEM MPDESJ Form Approved. .- +~ <br />MONITORING REPORT (OMR{e) ~ i N O:t OMB No. 2040-0004 <br />Approval expires 0531-9fi <br />003 d (BURR liii) <br />3ER DISCHARGE NUMBER p - FINAL tt •' L T C <br />INGPERIOD CI':_ ..~i:L TO ;; srA;:SY i:tii:EK <br />DA YEAR MO DAY -- <br />rz+-z5) zr! rzfi-za) (3o~3I) NOTE: Read Instructions before completing this forth. <br />(4 ~ ) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />15) 46-53) 5481 p( OF TYPE <br />UNITS ~ MINIMUM <br />AVERAGE MAXIMUM UNITS ""'"''"" <br />(R83) (64-68) 6 <br />#::. .:rfi ~4+r ~ ' <br />Y ;i <br />+ ~ s. <br />'~ •ht 44.... . <br />' <br /> <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY ET(AMINEO AND TELEPHONE DATE <br />T <br /> <br />~f,kM~ ~04 <br />0 <br />~ AM FAMILIAR WRH THE INFORMATIO SUBMnTED HERE <br />INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPON <br />THE INFORMATION <br />I BELIEVE THE S IN; AND BASED ON MY <br />SIBLE FOR OBTAINING <br />.. <br />. <br />`` 1/ , <br />UBMITTED INF <br />ACCURATE AND COMPLETE. I AM AWARE THAT THE <br />PENALTIES FOR SUBMITTING FALSE INFORMATIO ORMATON IS TRUE, <br />RE ARE SIGNIFICANT <br />N <br />INCLUDING THE <br /> <br />IV W ` ~ b r ~ , <br />POSSIBILRY OF FINE AND IMPRISONMENT <br />SEE 1B U <br />S <br />C <br />§ 1001 AND 33 U <br />S <br />C O~ <br /> . <br />. <br />. <br />. <br />. <br />. <br />. <br />4 1319. (PeneN/as untler arese smertas mey lnclutla Imes up b f10,W0 entl w SIGNATURE OF P NCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED <br />maximum lmpnsmment olbeMSen6mwrths entl5yeers.) OFFICER OR HORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell eaachments here) ` <br />°., :i S IFiJi+ LIf!I73 Ai Li. nF; s:AIY°D f; 5?T?L dAPLS 30L IL.; LL:!I" AFl'LI..C :'J~. <=I0Y6, LI: HB F'FN.CIF' ~V EtiT; T:,:i, <br />I?JV 5 3tICLEAoLr SuLiDS LIt`~ITS +'AIYCD POR >IUIR,2UHS Pr::CIr^ EVE.nT :,~.:JIC'L :'U sUhUcy JF FuUUF' !q I.A.2. <br />rI ~•vv,,l: _ cc. r p s ';yS •4pIS'2°•11 2- s i <br /> <br />EPA Form 3320.1 (OB-95) Previous editions may . <br />not be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.) <br />0000 4 / 99 0 513-114 0 <br />PAGE 2 OF <br />