PERMITTEE NAME/ADDRESS pnrrl,FrtliryNs,dLor.nm l/Dlpnrwp
<br />NAME (•'(1:KUJ cMNlkt Lhr.IlUh/~Tj:.-~.
<br />ADDRESS N G' UIJX uJ
<br />~cQA[~ cc a1DZo
<br />FACILITY I.YF'nv~ tMFII•`'[ l:Gr<r~UkAT iun
<br />LOCATIONLKAIV (, l; djb2h
<br />MIN MII,nAEL r.. LUULL;I+. ucNEkAL M6K
<br />NATIONAL POLLUTMT DISCNMOE ELIMINATION GYBTEM NPDE$J
<br />DISCHARGE MONITORING REPORT (DA~RI
<br />1-181 17-I9
<br />PERMIT NUMBER DISCNMOE NUMBER
<br />MONITO 1 G< RIOD
<br />YEAR MO DAY lSE R MO DAY
<br />FROM ~ TO :i U j 3I
<br />12SFLE3 f231 114-281 - 146171 128-291 13631/
<br />Form Approved.
<br />O 240-Q004.
<br />Itpproval e` plrpe b5-3~7 -~JS
<br />~Ucik Nr+ 1 7`t~
<br />F - FLtvAL
<br />rlihl7k
<br />t.tlr NL. ,; I SC;yARGt ~~ :•,,;•
<br />MOTE: Read Instruetlons balwa Fomplatinp this form.
<br />PARAMETER l3 Grs On/yl QUANTITY ORtOADI HG ~Onlp UANTITY OR CONCENTRATION
<br />~ NO. FREOUENLY SAMPLE
<br /> 146-531 _ !51-61 - 46-63 (51-6'1
<br />138-/5 EX
<br />132-J7/ A/,IKYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM : AVERAGE MAXIMUM UNITS raz•e~l !6.1.681 163701
<br />Nh SAMPLE t•X#### ###### ~ #ti•###M j~
<br /> MEASUREMENT
<br />l,tiuil 1 .", U ~.:.~:. ~:PEP.,MIT:.~.i.: : .:.iEtP.##A:#...
<br />~
<br />~ :.;.1[!?i<Y~~i:tl<it t•AL t. fi tii.>1'#i~!e. ~~: .y71(). ::
<br />:~ ~
<br />~ EtKL
<br />Y iit~3i Ct
<br />.
<br />- F
<br />rLUtnT ukU15 VALU :RE~UI1iEMEN7;
<br />......
<br />~• ..~:. .~. .
<br />:..
<br />: .~~
<br />~~~
<br />~ ;~... ~~ :.:..
<br />
<br />~
<br />##>:•#
<br />•::
<br />::.;>a=.:'';;.:.:;:r:...: .
<br />.:: <~: . .
<br />: .
<br />~LLIUSs T~~TAL SAMPLE +it##4t. 0####•i * *~ 19
<br />~L~f'tnUtU MEASUREMENT
<br />UC»U 1 U 0 .>c.. RMIT.:.:':. :;.##3k$Ih#:. ; ,..#E~##!ktM 44P ~f;lR?i'.~ ,..,: . ,,: ..:
<br />a
<br />~~
<br />.: ~ ,:.
<br />kl~Cr .:
<br />>Tt#m ~:
<br />~FrLUtNT UkU$5 VALU REQUIREMENT;'
<br />.. . da## ~';' ~
<br />AIL ANU uKEASE SAMPLE #####ti• t•~Fy•i#•'r M###~r+S• **fi~# 1')
<br />rKr.L.n LXTI<-i,RAV HCT MEASUREMENT R '
<br /> ,.::n
<br />........E MIT :.:..:..
<br />..:. .: :.. ~
<br />.::,: .. ...
<br />..::<..:
<br />,.,; .,.,. .. ,.
<br />, , ~...: ~:..::.... ,~. :.
<br />
<br />:
<br />
<br />
<br />r.`
<br />LFtLUC:>IT uRUS` YA U ;REQUIHEMEN'~:: :'.:.:. ;:,.,...... ,..:.r;::.:
<br />;::..
<br />:.':.: :.
<br />;
<br />l h,,n SAMPLE ####{•P t•##4## ###IU#IF 19
<br />IL1AL i<t L.LYEKADLE MEASUREMENT
<br />UU7DU 1 U U :~~:~:PE•RMIT~i;:'.:.' ~.:.::~#~#~lL~~tR~;!:::, '."..:::4'b#?ii!±h~ S•#i• ~ :~~~!.~IEj.P:T~'s ` '>r~.":' ::::::.::..
<br />:: [: ',:.i~~P1~1Zx:: ~:
<br />.';; ~.:~ ~:' II'IG~E:1?:' a;K1~'E~~:
<br />~FFLUtIVT uKUSS VALU REnuIAEMENT:
<br />...
<br />~ ##+F a• `l` .
<br />~ ": .
<br />hc.%: M6 L tSt~ly .h
<br />if.L SAMPLE 4#$$#4 4+F###i' #t~X•$## ~ ly
<br />IL.iAL nc..UVERAtiLE MEASUREMENT
<br />v lt, d4 1 0 0 :PERtiA1T~:~.~,.~
<br />::~.::~ .~'~ira?~#~R~~~:`... ?`?:':;*:?f~~:+1a1!'~*~. ##ti• .... ~ ~ . ,
<br />Sri-WCiol GK05S VALU .
<br />'FiEUUIHEM~NI ',,.~ ,p #.y„t 4 ~:
<br />,.,...,
<br />"~fl # ;ASTi:
<br />2 ':. ;~iX
<br />Iv /L
<br />~
<br />MLIIV :H'
<br />:::
<br />r LUnE Ih+ CliNOUlT ~+~ SAMPLE ~;} t•fi#*## #####fi #4t•at•4
<br />lnnU TkL.ATh;ENT FLAP! MEASUREMENT
<br />7 l,L~U 1 U 0 ::
<br />~PE[3MIi,~:.::i:
<br />, ~~ ~~,<;
<br />~f~C13.
<br />. :• ~_:-'fiEPl~t{~`.~ : ~: >H Y.l it&$#:`. ~!:`;r::#NF4•R*~+-:: .~ :~~~r`#i~~#iF~A!.# %: t•ti• ~E P~k~L:Y. ~ ~TAi
<br />
<br />~rrLUEivT LiKQS$ VALU .
<br />,
<br />REOUIREMEN'F:
<br />.:..::. :
<br />.
<br />~° ~'
<br />$flUA..ASt~;; ~ ~~~ ~~ ~ ~ ~
<br />
<br />`°RAI T. MX..
<br />
<br />MGU ~ ~ ~ .
<br />~ ~ ~ ~'~~
<br />„~: ,..::.::
<br />
<br />;.:
<br />
<br />t•~,~tiy
<br />
<br />
<br />. .
<br />•L SAMPLE
<br />. _ MEASUREMENT
<br /> PERMIT'...::. ,:.:.
<br />:.. :...:.
<br />':E:- i
<br />' IiEQUIF
<br />EM~N7
<br />' :
<br />..:::::~ ::~~~~~
<br /> :
<br />.
<br />i
<br />.
<br />~. ~... ~ :.. :...::. .: :,.
<br />..: ~' ..:.:..::x.. ~. .....: ,.. ~.' ~..
<br />~
<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF Lww THAT I
<br />HAVE PERSONALLY EAAMINEO MD
<br />AM fAMIUM N4TH THE INFORMATION SUBMIRED HEREIN
<br />MD GAGED ON
<br />- TELEPHONE DATE
<br /> ;
<br />MY INQUIRY Of THOSE 'IN[IIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />
<br />I'
<br />Irlli'rd !'
<br />91115 OBTNNINO THE INFORMATION, I BELIEVE THE GUBMIREO INFORMATION IS
<br />TRUE, ACCUMTp MD COMPLETE. I AM AWARE THAT THERE ME ~ j
<br />~ ~
<br />L '
<br />,
<br />. SIONIFCANi PENALi1EG FOq GUBMIRINO fALGE INFORMATION
<br />INCLUDING A
<br />r_nviror,rnental ti+IaEILtU C ,
<br />TNEPOS5IBNTYOFRNEMDIMPNGONMENT.9EEtBUS.C.It001M0G] BIONATUREOFPRINCIPALEXEgJTIVE 17 7 - 71 /1 ~~ 971
<br />
<br />TYPED OR PRINTED U.s.C. 1 t G16. I/WrIeM up.r Nr~ mum.. .Iar iKA.dI AMF w ro t IO,00p
<br />NOwmulmvn irWlor,wtr e/bfwwn 6navM. rW6yw..l
<br />OFFICER OR AUTNORRED AGENT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Ra/erenca s// stfschmenrs hare/
<br />~LL:p L1MlT AI'F'Llt~ TI, GLi:MnirvEU FLUrI FRW9 Ji;jF OLD v ,i~4• .)lL -. u,~tAst v+LA!1 SAHPL~ ANALT~IS ataJllt _~_ :I
<br />ri~1CLL ShEtrv 1~ t,:,St~tr`tL'. rkTKLY Sar.r~LI~G 1NSIkU(.fI'~i;i-I.L._„ Ni, X.
<br />EPA Form 3320-1 10&-961 Previous editions mey be used. (REPLACES EPA FORM Td0 WNICN MAY NOT BE USED.) UUU 1 ~3 ~ 961 J 01' 13.1 I PAGE iOF
<br />
|